Nama : David Christovan Setyaputra

NPM : 230210210068
Kelas :B
Judul Praktikum : Tugas Review Jurnal Praktikum TBA
Praktikum Teknologi Bahan Alam 2023

REVIEW JURNAL Q1 atau Q2

Judul Antioxidants and Sports Performance

Nama Jurnal Nutrients

Volume dan Halaman 15(2371)

Tahun 2023

Penulis Vicente Javier Clemente-Suárez, Álvaro Bustamante-Sánchez,

Juan Mielgo-Ayuso, Ismael Martínez-Guardado, Alexandra
Martín-Rodríguez, dan Jose Francisco Tornero-Aguilera.

Rangking (Q1/Q2)

DOI 10.3390/nu15102371

Tujuan Penelitian Untuk menganalisis peran spesies oksigen reaktif dan respons
antioksidan dalam performa olahraga.

Metode Penelitian Inklusi dan Eksklusi.

Hasil Pengaruh antioksidan terhadap stres oksidatif (apakah

pemberian antioksidan dapat mengurangi stres oksidatif yang
 terjadi selama olahraga). Stres oksidatif adalah kondisi di mana
produksi radikal bebas dalam tubuh meningkat dan dapat
menyebabkan kerusakan sel. Antioksidan dapat membantu
melindungi sel-sel dari kerusakan tersebut. Dampak
antioksidan terhadap pemulihan (apakah antioksidan dapat
mempengaruhi waktu pemulihan setelah latihan intensif).
Beberapa penelitian menunjukkan bahwa antioksidan dapat
membantu mengurangi peradangan dan mempercepat
pemulihan otot setelah olahraga. Performa olahraga yang
mengevaluasi apakah pemberian antioksidan dapat
meningkatkan performa atlet dalam berbagai aspek, seperti
kekuatan, daya tahan, waktu pemulihan, atau VO2max
(konsumsi oksigen maksimal). Variabilitas respons individu
(pengamatan respons individu terhadap pemberian
antioksidan). Beberapa penelitian telah menunjukkan bahwa
respons terhadap antioksidan dapat bervariasi antara individu,
dan faktor-faktor seperti genetik, diet, dan tingkat latihan dapat
mempengaruhi hasilnya.

Kelebihan Jurnal  Menggunakan bahasa yang lugas. Sehingga, semua inti

dalam jurnal tersebut tetap tersampaikan dengan baik.
 Urutan penulisan tersusun rapi. Karena memiliki
susunan yang baik, pembaca akan lebih mudah untuk
memahami seluruh isi dari jurnal tersebut.

Kekurangan Jurnal Tidak ada pemaparan dalam bentuk gambar maupun

dokumentasi untuk subjek penelitian pada jurnal ini.

Kesimpulan Ada semakin banyak bukti yang menunjukkan bahwa produksi

ROS selama aktivitas fisik
sangat memengaruhi performa olahraga. Tinjauan ini
menyimpulkan bahwa ROS memainkan
peran penting dalam proses adaptasi pelatihan yang diinduksi
oleh pelatihan resistensi,
melalui pengurangan mediator inflamasi dan stres oksidatif,
serta pensinyalan molekuler
yang sesuai. Selain itu, telah ditetapkan bahwa mikronutrien
memainkan peran penting
dalam menangkal radikal bebas, seperti spesies oksigen reaktif,
yang menyebabkan stres
oksidatif, dan efek antioksidan pada pemulihan, kinerja
olahraga, dan strategi penggunaan
suplemen antioksidan, seperti vitamin C. , vitamin E,
resveratrol, koenzim Q10, selenium, dan
kurkumin, untuk meningkatkan kesehatan fisik dan mental.
See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/370896933

Antioxidants and Sports Performance

Article  in  Nutrients · May 2023

DOI: 10.3390/nu15102371

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 nutrients
Review
Antioxidants and Sports Performance
Vicente Javier Clemente-Suárez 1, * , Álvaro Bustamante-Sanchez 1 , Juan Mielgo-Ayuso 2 ,
Ismael Martínez-Guardado 3 , Alexandra Martín-Rodríguez 1, * and José Francisco Tornero-Aguilera 1
Citation: Clemente-Suárez, V.J.;
Bustamante-Sanchez, Á.;
Mielgo-Ayuso, J.;
Martínez-Guardado, I.;
Martín-Rodríguez, A.;
Tornero-Aguilera, J.F. Antioxidants
and Sports Performance. Nutrients
2023, 15, 2371. https://doi.org/
10.3390/nu15102371
Academic Editor: Antoni Sureda
Received: 6 April 2023
Revised: 15 May 2023
Accepted: 16 May 2023
Published: 18 May 2023
Copyright: © 2023 by the authors.
Licensee MDPI, Basel, Switzerland.
This article is an open access article
distributed under the terms and
conditions of the Creative Commons
Attribution (CC BY) license (https://
creativecommons.org/licenses/by/
4.0/).
Nutrients 2023, 15, 2371. https://doi.org/10.3390/nu15102371
1 Faculty of Sports Sciences, Universidad Europea de Madrid, Tajo Street, s/n, 28670 Madrid, Spain
2 Department of Health Sciences, Faculty of Health Sciences, University of Burgos, 09001 Burgos, Spain
3 BRABE Group, Department of Psychology, Faculty of Life and Natural Sciences, University of Nebrija, C/del
Hostal, 28248 Madrid, Spain
* Correspondence: vctxente@yahoo.es (V.J.C.-S.); sandra.martin.rodriguez8@gmail.com (A.M.-R.)
Abstract: The role of reactive oxygen species and antioxidant response in training adaptations
and sports performance has been a large issue investigated in the last few years. The present
review aims to analyze the role of reactive oxygen species and antioxidant response in sports
performance. For this aim, the production of reactive oxygen species in physical activities, the effect
of reactive oxygen species on sports performance, the relationship between reactive oxygen species
and training adaptations, inflammation, and the microbiota, the effect of antioxidants on recovery
and sports performance, and strategies to use antioxidants supplementations will be discussed.
Finally, practical applications derived from this information are discussed. The reactive oxygen
species (ROS) production during physical activity greatly influences sports performance. This review
concludes that ROS play a critical role in the processes of training adaptation induced by resistance
training through a reduction in inflammatory mediators and oxidative stress, as well as appropriate
molecular signaling. Additionally, it has been established that micronutrients play an important
role in counteracting free radicals, such as reactive oxygen species, which cause oxidative stress,
and the effects of antioxidants on recovery, sports performance, and strategies for using antioxidant
supplements, such as vitamin C, vitamin E, resveratrol, coenzyme Q10, selenium, and curcumin to
enhance physical and mental well-being.
Keywords: inflammation; sports performance; antioxidant; reactive oxygen species; training; microbiota;
nutrition; physical activity
1. Introduction
A substance that can slow down the oxidation of proteins, carbohydrates, lipids, and
DNA at low concentrations is called an antioxidant. There are three main categories of
antioxidants [1]: the first line of defense includes substances such as superoxide dismutase,
catalase, glutathione reductase, and minerals such as selenium, copper, and zinc. The sec-
ond line of defense includes substances such as glutathione, vitamin C, albumin, vitamin E,
carotenoids, and flavonoids. The third line of defense includes a complex group of enzymes
that repair damaged DNA, proteins, oxidized lipids, and peroxides. Examples include
lipase, protease, DNA repair enzymes, transferases, and methionine sulphoxide reduc-
tase.An imbalance between reactive oxygen species (ROS) and antioxidant defenses results
in oxidative stress, which can disrupt cellular functions and lead to various pathological
conditions such as AIDS, aging, arthritis, asthma, autoimmune diseases, carcinogenesis,
cardiovascular dysfunction, cataracts, diabetes, and neurodegenerative diseases such as
Alzheimer’s disease and Parkinson’s dementia, among others [2].
In relation to exercise, during exercise, the metabolism speeds up due to the increased
need for oxygen. This causes the release of highly reactive oxygen species (ROS) from the
mitochondria. Physical exertion itself also triggers the activation of enzymes, which in turn
increases the number of ROS [3], which can harm cells and contribute to muscle damage,
https://www.mdpi.com/journal/nutrients
Nutrients 2023, 15, 2371 2 of 35

fatigue, and immune problems. However, they also have positive effects, such as aiding in
glycogen resynthesis, reducing the risk of infection, and enhancing athletic performance
through adaptive responses to training. Whether ROS are harmful or helpful depends on
factors such as exercise duration, intensity, fitness level, and nutrition [4].
Thus, intense exercise can increase the production of free radicals or reactive oxygen
species (ROS) and nitrogen species (RONS), which can hinder muscular contractile function
and cause muscle fatigue and reduced performance [5]. To combat muscle damage and
fatigue and enhance performance, athletes often consume antioxidant supplements. How-
ever, recent research suggests that the positive effects of antioxidants on health and sports
performance may also produce harmful effects in high doses [6]. Indeed, the American
College of Sports Medicine suggests that around half of athletes use vitamin supplements
to maintain fitness and boost stamina [7]; yet, from this percentage, another 50% of elite
endurance and male collegiate athletes consumed doses of antioxidant supplements daily
that were higher than the recommended daily allowance (RDA) [6]. This consumption
and such high doses are often based on the mistaken assumption that antioxidants are
unlikely to be toxic and can prevent the harmful effects of reactive oxygen species (ROS)
on cell structure and function. However, there is evidence that ROS play important roles
in physiological signaling pathways that regulate the response to exercise, and oxidative
stress induced by physical activity is essential for training adaptation. This means that
the appropriate balance between antioxidants and free radicals is necessary for obtaining
physiological adaptation, and the use of antioxidants in athletes may negate the beneficial
effects of ROS in normal cell signaling [8].
In this line, reactive oxygen species generated during exercise are believed to stimulate
molecular pathways, including PGC1-α and MAPK, which are critical to aerobic capac-
ity and muscle hypertrophy [9]. Some authors suggest that a transient increase in ROS
induced by exercise can have positive effects, such as regulating muscle contractile activity,
stimulating muscle regeneration, and improving vasodilation during exercise. However,
high levels of ROS and oxidative stress can cause inflammation and damage to cells and
tissues. Despite their high training demands, many endurance athletes have diets that
lack sufficient antioxidants to support their physical activity demands [10]. While it is
often recommended that endurance athletes take antioxidant supplements, given the many
proven health benefits of exercise, this approach may not be necessary.
In relation to sports performance, some of the most commonly used anti-redox supple-
ments by athletes with the aim of improving performance may have a potentially negative
effect on physical performance, depending on the dosage. This may be the case with
vitamin C, as ROS may facilitate beneficial adaptations from training, but vitamin C can
hinder these adaptations. Out of 12 studies, 4 showed substantial impairments in sports
performance from vitamin C doses of 1 g or more daily, potentially by decreasing mitochon-
drial biogenesis. Another four studies showed impairments but not significant enough to
be statistically relevant. Three out of four studies reported performance improvements
but only when vitamin C was taken acutely or for a short period of up to 1 week. The
conclusion drawn in this review was that consuming lower doses of vitamin C from fruits
and vegetables (up to 250 mg daily) can reduce oxidative stress and offer health benefits
without affecting training adaptations negatively [11,12].
Despite the potential negative effects of vitamin C on performance, previous stud-
ies have proposed ways in which other antioxidants could enhance either muscular or
cardiovascular performance. In this line, vitamin E has been suggested by researchers
as a helpful supplement to maintain the structure of red blood cells during exercise at
high altitudes, which could be translated into training in hypoxia [13]. Furthermore, re-
searchers also suggest that polyphenols, including quercetin, may induce mitochondrial
adaptation and improve peripheral circulation, similar to exercise [14]. In this line, high
doses of certain polyphenols, such as quercetin and resveratrol, may also promote mi-
tochondrial biogenesis by activating peroxisome-proliferator-activated receptor gamma
coactivator 1-alpha through adenosine-monophosphate-activated protein kinase, leading to
Nutrients 2023, 15, 2371 3 of 35

improved endurance capacity [15], also increasing nitric oxide synthesis in the endothelium,
improving blood flow.
Beetroot juice, which is rich in polyphenols and inorganic nitrate, can also impact
oxygen utilization and blood flow [16]. Spirulina contains various antioxidants, such as
tocopherol, β-carotene, polyphenols, and phytocyanins, all of which can reduce exercise-
induced reactive oxygen species [17]. Another example would be N-acetyl cysteine (NAC),
which can directly scavenge reactive species and provide cysteine for glutathione synthesis,
an essential intracellular antioxidant [18].
In summary, physical exercise is a fundamental tool for health and physical per-
formance. However, when the training load or volume is too high, ROS appear as a
consequence. In this line, athletes seek ways to mitigate the negative effects of ROS at
a physiological level; however, the lack of knowledge and scientific literature may lead
the athletes to an inappropriate dose and intake of antioxidants, thus having a negative
effect by inhibiting molecular signaling pathways in processes such as angiogenesis and
muscle hypertrophy. ROS and RONS are essential in the processes of adaptation to training,
through an attenuation of inflammatory factors and oxidative stress as well as correct
molecular signaling; therefore, a balance is necessary.
Thus, the present narrative review provides a comprehensive overview of the complex
interplay between ROS, antioxidants, and exercise and sheds light on the potential benefits
and limitations of antioxidant interventions in the context of sports performance. The aim
is to explore the effects of ROS production on sports performance, training adaptation, and
recovery, as well as the role of antioxidants in mitigating the harmful effects of ROS [18–20].
Understanding performance from a holistic perspective, such as microbiology and the
relationship between antioxidant capacity and the microbiota, shows the potential benefits
of an antioxidant-rich diet and antioxidant supplementation for sports performance. Finally,
practical applications and strategies for antioxidant supplementation in sports competitions,
including the timing and dosage of antioxidant supplements, will be studied.

2. Materials and Methods

A literature search was conducted for this study using both primary and secondary
sources, including scientific articles, bibliographic indexes, and databases such as PubMed,
Scopus, Embase, Science Direct, Sports Discuss, ResearchGate, and the Web of Science.
MeSH-compliant keywords such as antioxidants, exercise, performance, adaptation, recov-
ery, supplementation, and the gut microbiota were used to search for articles published
from 1 January 2003 to 1 January 2023. To determine the inclusion criteria, a team of six
review authors screened the titles and abstracts of all retrieved manuscripts. Exclusion
criteria were then applied to studies that used old data outside the proposed timeline,
had inappropriate topics that were not relevant to the study’s focused purpose, or were
not written in English. The same team of nine review authors who conducted the study
selection extracted the information from the selected studies. The studies were selected
independently, and the results were discussed to produce the present narrative review.

3. Physical Exercise and Reactive Oxygen Species Production

Frequent physical activity provides systemic benefits, including the enhancement
of brain function. However, unaccustomed strenuous exercise can lead to muscle injury,
inflammation, and oxidative stress. Reactive oxygen species (ROS) are produced during re-
peated muscular contraction, with mitochondria, NADPH oxidase enzymes (NOX/DUOX),
and xanthine oxidase (XO) being the main sources of ROS during exercise (Figure 1). While
mitochondria and XO produce oxygen as by-products of oxidative phosphorylation and
purine metabolism, respectively, NOX enzymes are responsible for producing superoxide
(O•−2 ), hydrogen peroxide (H2 O2 ), and hydroxyl radical (•OH) [21] (Figure 1).
Nutrients Nutrients 2023, 15, x FOR PEER REVIEW 
2023, 15, 2371 4 of 35 6  of  37 
 

 
Figure 1.Figure 1. Response against ROS in trained and untrained individuals. 
Response against ROS in trained and untrained individuals.

Normal muscular force requires moderate levels of ROS, but excessive ROS can
4. The Effect of Reactive Oxygen Species on Sports Performance 
lead to muscle exhaustion and contractile failure. However, some studies have shown
The precise redox pathways causing exercise-induced oxidative stress and exercise-
that oxidants at low concentrations may be crucial for enhancing muscle contraction, as
induced adaptability are still not fully understood. Our comprehension of muscle exhaus-
exogenous antioxidant therapies have been shown to decrease muscular contractility, but
tion and recovery after exercise, as well as the creation of prospective methods for ROS 
this effect is reversed when hydrogen peroxide is added (Figure 1). On the other hand,
measurement in active muscles, may be improved by investigating ROS pathways. Alt-
excessive ROS production combined with weakened antioxidant defenses due to strenuous
hough there is growing evidence linking exercise to an increase in oxidative stress, sys-
exercise or other stresses may result in oxidative stress and tissue damage [22]. As a
tematic research on how exercise-related activities (such as exercise type, intensity, and 
result, the adaptive response to regular exercise is characterized by the upregulation of the
enzymaticduration) 
antioxidantaffect system
ROS  generation  is  still 
and the control oflacking  [21]. 
oxidative Traditionally, 
damage exercise  is  separated 
(Figure 1).
into aerobic and resistance training components. Aerobic exercise strengthens the cardio-
Under physiological circumstances, it is well established that mitochondrial cellular
vascular system and decreases reactive oxygen species and several ROS-related responses 
respiration results in the production of ROS. Exercise-induced ROS formation can occur
dramatically as exposed in Figure 2. As a direct consequence, it is critical to distinguish 
through cytoplasmic glucose metabolism and NADH regeneration, as well as increased
between training methods that call for a high level of athletic performance. The knowledge 
ATP hydrolysis rates and purine metabolism, which may be associated with the increased
presented here is focused on endurance, strength, and high-intensity training, as well as 
energy metabolism demand after physical activity. Fast-twitch fibers, which have high
levels ofmountain sports because of the distinctive properties of ROS at high altitudes (Figure 2). 
glycogen and use glycolysis as their primary ATP source, are the main sources
Exercise-induced oxidative stress is mitigated by aerobic exercise, which boosts anti-
of lactate release, and lactate is generated in an intensity-dependent manner. Data sug-
oxidant 
gest that NADPH levels  and  antioxidant 
oxidases enzyme 
could generate ROS expression  [44].  Conversely, 
from the elevated intramuscularresistance 
NADHtraining 
promotes structural (i.e., muscle fiber) and neurological adaptations while also causing 
levels resulting from energy metabolism. Recent research has shown that the ability of
an increase in oxidative and inflammatory stress. Due to elevated levels of oxidative and 
intestinal cells to convert lactate into pyruvate results in the production of NADH, which
can then inflammatory stresses brought on by resistance training, the recovery time reduces oxida-
activate NADPH oxidases. In this regard, the NOX4 enzyme may function as
tive stress and allows for the repair of minor injuries. Indeed, in skeletal muscle, intense 
a metabolic sensor by connecting exercise-induced ROS generation to ATP metabolism
physical 
due to the presence activity 
of ancan  generate  high 
ATP-binding motifproduction  of  ROS 
in its structure and and  reactive 
its control by nitrogen 
ATP [23].species 
(RNS). A large concentration of reactive species might be hazardous to the organism if it 
Specifically, NOX and XO are the major endogenous ROS producers in skeletal muscle.
is not neutralized by the available antioxidant enzymes, depending on the activity level, 
While superoxide produced by mitochondria may be detected in both resting and active
muscles, duration, frequency, sex, age, and fitness [45]. For instance, locally generated IGF-1 made 
evidence has suggested that mitochondria may not be the primary generator of
ROS in by muscle cells, which acts autocrine and paracrine, is thought to be the most important 
exercising muscles. On the contrary, NOX is a significant ROS producer during
muscle hypertrophic stimulation. Among the compounds produced by IGF-1 posttranscriptional 
contractions, contributing more to cytosolic superoxide than mitochondria. During
exercise,regulation is mechano growth factor (MGF). Both proteins are regarded as crucial media-
NOX-induced ROS in T-tubules can dramatically affect ryanodine receptor type 1
to increase
tors calcium (Ca2+ ) release skeletal 
of  exercise-induced  and muscular
muscle  contractions [24]. Moreover,
growth,  which  can  occur XOvia promotes
ROS  signaling. 

 
Nutrients 2023, 15, 2371 5 of 35

the formation of extracellular superoxide during isometric contraction by being present in

the endothelium and cytoplasm of the muscle. This XO-derived superoxide is essential for
the production of muscular power [25]. Considering the quantity of exercise performed,
untrained subjects are more susceptible to the negative consequences of increased oxidative
stress, whereas trained individuals often have diminished effects due to higher oxidative
tolerance (Figure 1). According to an analysis of the cell signaling pathways controlling
these skeletal muscle changes, a recent systematic review stated that redox signaling path-
ways play a critical role in the regulation of muscle remodeling during both exercise and
extended periods of rest [26–28].
Normally, intracellular antioxidants such as bilirubin, vitamin E, or vitamin C are
located within cells, the cytoplasm, and organelles (such as mitochondria) to protect muscle
fibers from damage induced by reactive oxygen species (ROS). However, increased gen-
eration of ROS during vigorous and exhaustive exercise can counteract these protective
processes [29–32]. Indeed, although most studies have focused on the harmful effects of
exercise-induced oxidative stress on muscles, researchers have recently reported the impor-
tance of ROS in initiating and regulating the body’s adaptive responses to exercise [33,34].
Significant routes in the adaptive responses to training have been proposed. The activation
of the primary signaling pathways involved in muscle adaptation is thought to depend on
the generation of mitochondrial reactive oxygen species during routine exercise [35]. The
main regulator of antioxidants as well as other cytoprotective cofactors is nuclear factor ery-
throid 2-related factor (Nrf2), a redox-sensing transcription factor that is responsible for the
increased antioxidant defense mechanism [36]. Enhancing mitochondrial biogenesis through
elevated peroxisome proliferator-activated receptor-gamma coactivator-1 alpha (PGC-1 al-
pha) gene expression is another adaptation to exercise. The redox-sensitive upstream signals
that regulate PGC-1 alpha expression include mitogen-activated protein kinase (MAPK)
and nuclear factor (NF)-kB [37]. Other cellular signaling pathways, such as 5-adenosine
monophosphate-activated protein kinase (AMPK), p38 mitogen-activated protein kinases
(p38 MAPK), and Ca2+ /calmodulin-dependent protein kinase, are also triggered by muscle
contraction and increased PGC-1 alpha mRNA levels (CaMK) [38]. Importantly, failure to
trigger some of the aforementioned exercise effectors may result in a disruption in redox
signaling caused by antioxidant supplementation. For instance, PGC-1 alpha was shown to
be triggered in electrically stimulated myotubes by cAMP response element binding protein
(CREB) signaling via superoxide produced by NOX2 [39]. Previously, PGC-1 alpha was
believed to be the main player in adaptations to endurance exercise. However, resistance
training was found to induce PGC-1 alpha 4, a shortened splice version of PGC-1 alpha, but
not endurance training. The expression of PGC-1 alpha 4 was linked to the hypertrophic
muscle response but was unable to enhance IGF-1 or the same group of oxidative genes,
such as TFAM, PGC-1 alpha, and NRF2 [40]. Therefore, recent research has identified PGC-1
alpha as a key factor in coordinating both resistance (myogenic) and endurance (oxidative)
adaptations to exercise.
In this line, endurance exercise increases metabolism, which often leads to induced
oxidative stress and injuries. It is estimated that aerobic exercise causes a 1–3 times increase
in O•−2 during muscle contraction. However, mitochondria only contribute a minor
amount to the production of O•−2 during aerobic exercise [22,25]. Sprinting, on the other
hand, primarily uses anaerobic energy pathways due to its high energy demands. Only
a small amount (0.15%) of O•−2 is generated in the mitochondria during sprinting. The
relatively reduced oxygen consumption and higher ADP (state 3) during sprints result
in lower ROS generation in skeletal muscle mitochondria than typical [41]. NOX is one
of the potential locations for O•−2 generation during rapid muscle contraction. Another
significant factor for the generation of ROS is the activation of XO caused by an increase
in hypoxanthine during and after sprints [42]. It is critical to emphasize that only a
small number of studies have attempted to examine ROS-mediated cellular signaling
after resistance training programs. For instance, greater research is required to determine
whether PI3/Akt functions as a redox-sensitive cascade to promote hypertrophy [43].
Nutrients 2023, 15, 2371 6 of 35

Although physical activity associated with sports performance will be covered in detail in
the following sections, it is necessary to mention that the formation of ROS during skeletal
muscle contraction and physical activity has been the subject of intense discussion for the
past four decades and still is. Reactive oxygen species (ROS) are still difficult to detect
due to their instability and methodological challenges, but significant advancements have
been made recently, particularly in the development of imaging techniques and the use of
redox-active biosensor compounds to detect ROS produced in subcellular environments.

4. The Effect of Reactive Oxygen Species on Sports Performance

The precise redox pathways causing exercise-induced oxidative stress and exercise-
induced adaptability are still not fully understood. Our comprehension of muscle ex-
haustion and recovery after exercise, as well as the creation of prospective methods for
ROS measurement in active muscles, may be improved by investigating ROS pathways.
Although there is growing evidence linking exercise to an increase in oxidative stress,
systematic research on how exercise-related activities (such as exercise type, intensity, and
duration) affect ROS generation is still lacking [21]. Traditionally, exercise is separated into
aerobic and resistance training components. Aerobic exercise strengthens the cardiovas-
cular system and decreases reactive oxygen species and several ROS-related responses
dramatically as exposed in Figure 2. As a direct consequence, it is critical to distinguish
between training methods that call for a high level of athletic performance. The knowledge
Nutrients 2023, 15, x FOR PEER REVIEW  9  of  37 
  presented here is focused on endurance, strength, and high-intensity training, as well as
mountain sports because of the distinctive properties of ROS at high altitudes (Figure 2).

 
Figure 2. ROS and antioxidant response in sports performance.
Figure 2. ROS and antioxidant response in sports performance. 
Exercise-induced oxidative stress is mitigated by aerobic exercise, which boosts an-
5. Training Adaptation and Reactive Oxygen Species 
tioxidant levels and antioxidant enzyme expression [44]. Conversely, resistance training
5.1. ROS in the Skeletal Muscle 
promotes structural (i.e., muscle fiber) and neurological adaptations while also causing
an increase in oxidative and inflammatory stress. Due to elevated levels of oxidative
Reactive oxygen species (ROS) have conventionally been viewed as harmful constit-
and inflammatory stresses brought on by resistance training, the recovery time reduces
uents; however, it is now recognized that they are compelling signaling molecules that 
control physiological processes. Mitochondria in skeletal muscle cells typically generate 
ROS. Various conditions, including instances of strenuous contractile activity, can result 
in heightened mitochondrial ROS production during exercise [62]. Specifically, superox-
ide  production  in  skeletal  muscles  can  rise  up  to  50–100  times  during  aerobic  exercise 
Nutrients 2023, 15, 2371 7 of 35

oxidative stress and allows for the repair of minor injuries. Indeed, in skeletal muscle,
intense physical activity can generate high production of ROS and reactive nitrogen species
(RNS). A large concentration of reactive species might be hazardous to the organism if it
is not neutralized by the available antioxidant enzymes, depending on the activity level,
duration, frequency, sex, age, and fitness [45]. For instance, locally generated IGF-1 made
by muscle cells, which acts autocrine and paracrine, is thought to be the most important
hypertrophic stimulation. Among the compounds produced by IGF-1 posttranscriptional
regulation is mechano growth factor (MGF). Both proteins are regarded as crucial mediators
of exercise-induced skeletal muscle growth, which can occur via ROS signaling. During
exercise-mediated hypertrophy signaling, phosphatase and tensin homolog (PTEN) and
protein phosphatase 2A (PP2A) regulate two essential steps in PI3K/Akt signaling and are
susceptible to H2O2-mediated signaling. In addition to the temporary suppression of PTEN,
H2O2-mediated signaling causes the phosphorylation of PTEN, leading to its destruction.
Furthermore, isometric exercise is widespread in daily activities involving static positions,
such as carrying heavy objects. Many biomarkers of oxidative stress have been investigated
in response to isometric exercise, but the results have been inconsistent. Isometric contrac-
tions, for instance, result in elevated levels of hydroperoxide and blood protein carbonyls.
Nevertheless, malondialdehyde levels in plasma remain unchanged [21,34]. Additionally,
a small number of studies have also evaluated the oxidative stress caused by eccentric
exercise, a physical activity that can cause sarcolemma inflammation and consequent ROS
overproduction and muscle injury [46]. However, over time, the adaptations brought on by
consistent, vigorous exercise diminish the overall oxidative stress [47].
Focusing on high-intensity exercise, a recent study assessing a variety of these activities
in athletes deduced that it mainly results in the production of extra reactive oxygen species
(ROS) in skeletal muscle. Therefore, athletes must preserve increased ROS scavenging
activity in the body [48]. The active sympathetic nervous system can contribute to the
generation of ROS in response to vigorous exercise. As a result, Bors et al. showed that
administering adrenaline significantly raised H2O2 levels in vitro [49]. According to earlier
studies, the body’s oxygen intake during intense activity is 10–15 times larger than at
rest, and the oxygen uptake by active muscles is approximately 100 times greater [50].
Although it has been hypothesized that an increase in ROS and free radical production
in the body may result in tissue damage, inflammation, and various oxidative diseases,
extreme anaerobic exercise significantly boosted the scavenging activities of various serum
reactive oxygen species and free radicals, according to recent findings [48]. In this regard,
the alterations in these scavenging activities vary significantly for each reactive oxygen
species and free radical in response to intense exercise stress. When Sawada et al. compared
medium–high power groups with medium–low power groups, the rate of increase in OH
was substantially larger in the medium-high power group compared to the medium-low
power group. This suggests that the amount of antioxidant myokines released immediately
following exercise varies between individuals. In other words, exercise performance
may be connected with an athlete’s ability to release antioxidant myokines. The findings
show that those with greater exercise performance are more susceptible to the oxidative
stress induced by exercise interventions, suggesting that those who are able to respond
to the rapid oxidative stress caused by high-intensity exercise are capable of achieving
greater performance (Figure 2) [48,51]. However, there is evidence that NOX2 is activated
by high-intensity interval training and that functional NOX2 is necessary for long-term
training adaptation. Examples of this data include enhanced muscle protein expression
of antioxidant defense enzymes, mitochondrial enzymes, and hexokinase II, as well as
increased mitochondrial network volume and decreased mitochondrial fragmentation [52].
In addition, XO activation induced by an increase in hypoxanthine during and after sprints
is regarded as a major factor in ROS generation.
Although isolated bouts of intense aerobic exercise have the potential to induce ox-
idative damage to muscle fibers, regular aerobic exercise improves the cellular capacity to
detoxify accumulated reactive oxygen species (ROS) [53]. Frequent or moderate exercise
Nutrients 2023, 15, 2371 8 of 35

has been shown to enhance antioxidant defense by increasing the activity of endoge-
nous antioxidant enzymes such as catalase, GPx, and superoxide dismutase (SOD) [54].
Exercise protects the body against ongoing mild or moderate ROS exposure through
redox-associated preconditioning, including repair processes for oxidative damage. In fact,
long-term resistance and endurance training promote muscle mitochondrial proliferation,
and the combination of both training modalities results in a more pronounced reduction in
oxidative damage to lipids and carbohydrates, as well as a higher increase in antioxidant
enzyme activity, indicating that combining the two types of exercise is beneficial in prevent-
ing type 2 diabetes [47]. Additionally, a study focused on untrained men revealed that all
three types of training, including endurance training, resistance training, and concurrent
training (a combination of endurance and resistance), can reduce oxidative stress [55].
The adaptation is mediated by moderate exercise and involves an increase in myocellular
antioxidant capacity, which helps to reduce ROS levels. Results from marathoners showed
that ROS generation peaked in the middle of the race, but then returned to baseline levels
at the finish line, suggesting that an antioxidant defense mechanism may be activated
after the run to mitigate oxidative stress [56]. Furthermore, Sahlin et al. demonstrated in
ultra-endurance exercises that exercise increases ROS generation in isolated mitochondria
from human muscle in a reversible manner without showing any signs of a harmful vicious
cycle [57]. Using electron spin resonance spectroscopy (ESR) and plasma malonaldehyde
(MDA) concentrations, another study investigated the relationship between delayed onset
muscle soreness (DOMS), muscle function, and ROS after downhill running in sports
performance such as trail running. Although a 15% gradient increased ROS generation, the
rise occurred after the peak in DOMS and decreased muscle function, indicating that there
may be a temporal decoupling between ROS, the loss of muscle function, and DOMS [58].
Continuing from the previous paragraph and specifically related to mountain sports
performance, physical training at high altitudes can exacerbate oxidative stress, thereby
playing a significant role in ROS generation. Hypobaric hypoxia, in particular, leads to
a high number of ROS, resulting in potential tissue damage for mountaineers in the fu-
ture [59]. In fact, a recent review has shown that ROS generation not only affects athletes
but also a growing number of people who live or work at high altitudes with hypobaric hy-
poxia. This causes various changes in the body’s physiology, biochemistry, and molecules,
leading to the development of hypoxic pulmonary vasoconstriction (HPV), remodeling,
and pulmonary hypertension (PH) [60]. Additionally, hypoxia can activate several sources
that produce reactive oxygen species and RNS, resulting in oxidative damage that can
affect cellular performance and significantly decrease organ function. Moreover, it appears
that both the enzymatic and non-enzymatic antioxidant systems are weakened by high
altitudes. Recent findings indicate that the expression of Mn-SOD in the skeletal muscle of
mountaineers who spent more than 6 weeks at an altitude of 6000 m dropped considerably
one week after leaving the altitude. Furthermore, exposure to high altitudes increased
the expression of Ku70, a gene involved in DNA repair, indicating increased DNA dam-
age [53]. To combat this oxidative stress and maintain the balance between pro-oxidants
and antioxidants, the human body has an antioxidant system that may be overwhelmed
by increasing ROS levels but can be reinforced with antioxidant supplements [61]. How-
ever, inconsistency in the findings of numerous studies persists, likely due to variations in
exercise regimens and assessment techniques for ROS in skeletal muscle.

5. Training Adaptation and Reactive Oxygen Species

5.1. ROS in the Skeletal Muscle
Reactive oxygen species (ROS) have conventionally been viewed as harmful con-
stituents; however, it is now recognized that they are compelling signaling molecules that
control physiological processes. Mitochondria in skeletal muscle cells typically generate
ROS. Various conditions, including instances of strenuous contractile activity, can result
in heightened mitochondrial ROS production during exercise [62]. Specifically, superox-
ide production in skeletal muscles can rise up to 50–100 times during aerobic exercise
Nutrients 2023, 15, 2371 9 of 35

contractions [63]. ROS generated by mitochondria are a constant by-product of cellular

metabolism, and their control is crucial for maintaining proper cellular function. Studies
have demonstrated an atypical regulation of AMPK by mitochondrial ROS, which pre-
serves cellular metabolic balance by prompting a PGC-1a-mediated antioxidant reaction.
This response restricts mitochondrial ROS production and regulates HIF-1a stabilization,
thereby enhancing stress tolerance and sustaining metabolic homeostasis [64].
However, recent findings indicate that mitochondria may not be the primary source
of ROS during exercise, and further investigation is necessary to fully comprehend the
involvement of mitochondria in ROS production during skeletal muscle contractions [62].
The reduced rate of superoxide generation can be attributed to uncoupling proteins, par-
ticularly UCP3, in skeletal muscle, which function as regulators of mitochondrial ROS
production to prevent oxidative harm to mitochondria [65]. Additionally, emerging data
suggest that mitochondria produce more ROS during state 4 (basal respiration) than during
state 3 (maximal ADP-stimulated respiration) [66,67]. As skeletal muscle mitochondria
are primarily in state 3 during aerobic contractions, their capacity to produce ROS during
contractions is limited [66,67].
Heat shock proteins (HSPs) are known to play a critical role in safeguarding cells
from various stress conditions, with exercise being a primary trigger for HSP expression.
This expression can be prompted by a combination of stressors, in which ROS may exert a
significant influence, as moderate levels of ROS serve as regulatory mediators in signaling
pathways that shield cells from oxidative stress response [68].
Several studies have shown that high-intensity physical activity can result in oxidative
stress, irrespective of the type of exercise, while other research has observed no significant
changes in oxidative stress markers [69]. Follow-up investigations have investigated the
effects of acute exercise and training on the body’s inherent antioxidant defense mecha-
nisms. The findings demonstrate that acute exercise reduces the antioxidant capacity in
the immediate post-exercise period but enhances it during the subsequent recovery period.
Furthermore, these studies have revealed that physical training reduces ROS production
during rest while boosting the body’s inherent antioxidant defense mechanisms [69].
Regular exercise not only offers systemic advantages to brain function by altering the
cellular redox state but also enhances neurogenesis and cytokine production and reduces
the accumulation of oxidative damage [53].

5.2. ROS in Endurance Training

The involvement of reactive oxygen species in the enhancement of performance- and
health-related parameters induced by endurance training has a dual aspect. Endurance
training performed regularly is advantageous and provides preventive effects against
numerous diseases, delays symptoms of depression and neurodegeneration, and supports
healthy aging by promoting mitochondrial biogenesis and oxidative metabolism. However,
excessive exercise can hinder the adaptive process, leading to maladaptation and potentially
an increased risk of developing diseases [70]. Investigations using cultured cells have
demonstrated that ROS act as a trigger to induce mitochondrial biogenesis and increase the
mRNA and protein expression of antioxidant enzymes [71].
On the other hand, the results of in vivo studies have been conflicting, and there is no
consensus regarding the role of ROS as a trigger. Previous research suggests that ROS are
involved in the stimulation of mitochondrial biogenesis induced by endurance training [72].
Other investigations have indicated that improved insulin sensitivity, as measured by the
glucose infusion rate (GIR) and plasma levels of adiponectin, was only observed in the
absence of antioxidants following endurance training [73].
Alternatively, a human-subject investigation was carried out to examine the impact of
the administration of vitamins C and E on glycogen concentration, citrate synthase activity
in skeletal muscle, maximal oxygen uptake, and endurance performance in response to
endurance training [74]. The results showed that there was no effect on any of these param-
eters. Furthermore, the impact of antioxidant administration during rigorous endurance
Nutrients 2023, 15, 2371 10 of 35

training on the enhancement of insulin-stimulated glucose uptake in healthy individuals

was investigated [75]. The study revealed that the administration of antioxidants did not
alter the improvement in glucose uptake induced by training.
Earlier research sought to examine the impact of training and/or antioxidant supple-
mentation (vitamin E and alpha-lipoic acid) on skeletal muscle adaptations in rats [76].
Through an enhanced study design, it was discovered that antioxidant supplementation
led to a reduction in the overall level of mitochondrial biogenesis, while still permitting the
induction of mitochondrial biogenesis induced by endurance training. In essence, although
antioxidant supplementation does not impede endurance training-induced mitochondrial
biogenesis, it does result in a decrease in the overall level of mitochondrial biogenesis.
Endurance exercise triggers the activation of numerous intracellular signaling path-
ways, which promote mitochondrial biogenesis, angiogenesis, and heightened insulin
sensitivity [77]. Earlier research has demonstrated that modifications in intracellular en-
ergy and calcium status during exercise function as the principal triggers. Contemporary
investigations propose that ROS also serve as a stimulus during exercise. Additionally, the
activation of the beta-adrenergic system and elevation of free fatty acid concentration have
been identified as supplementary stimuli [78]. In this line, ultra-endurance exercise boosts
the generation of mitochondrial ROS, which is linked to plasma-free fatty acid levels, yet it
does not inevitably lead to oxidative harm to mitochondrial proteins [79].
To obtain a more comprehensive comprehension of the functions of ROS and antiox-
idants in exercise-induced adaptations, forthcoming investigations should consider the
following suggestions. Initially, it is crucial to acknowledge that there are diverse sites
of ROS production, which are reliant on the training conditions, such as intensity, dura-
tion, and environmental factors. Consequently, endeavors should be made to pinpoint
the locations or compartments of ROS production and the repercussions of antioxidants
on the redox status under each exercise condition [80,81]. To achieve this objective, it
is advisable to evaluate multiple biomarkers of oxidative stress or redox status across
various sites of ROS production. Secondly, it is essential to consider the redundancy of
in vivo cellular signaling involved in adaptations induced by endurance training. Thus,
forthcoming investigations should assess the relative importance and interconnections of
signaling pathways emerging from distinct initial stimuli originating from exercise under
every training condition [82].

5.3. Role of Reactive Oxygen Species (ROS) in Resistance Training

Resistance training (RT) can stimulate an increase in reactive oxygen species (ROS),
which may result in muscle damage and fatigue. Antioxidant supplements are commonly
ingested to mitigate these adverse effects, but recent studies suggest that ROS also play a
significant role in cellular adaptation. Traditionally, the role of ROS in muscle damage and
fatigue has been explored in the context of endurance training [83].
Consensus holds that heightened production of ROS has detrimental outcomes, as they
are known to cause harmful effects. However, it should be acknowledged that ROS also
have the ability to stimulate beneficial stress, known as eustress [84]. Therefore, ROS serve
as important signaling molecules in redox regulation [85]. Nevertheless, uncontrolled and
excessive production of ROS can lead to the formation of peroxides and damage cellular
components such as proteins, lipids, and DNA [84,86]. In fact, it is believed that an increase
in ROS generation is a contributing factor to the onset of degenerative diseases, aging, and
muscle wasting [87,88].
Regarding RT, an 8-week study investigating the impact of endurance training, RT,
and concurrent training on antioxidant capacity and oxidative stress markers in untrained
individuals concluded that all groups demonstrated significant improvements in superox-
ide dismutase activity and noteworthy reductions in malondialdehyde levels, indicating
that RT (at intensities greater than 50% of 1RM) brings about comparable changes in redox
status as endurance training [55].
Nutrients 2023, 15, 2371 11 of 35

Middle-aged men (aged 53.9 ± 2.3 years) who underwent 21 weeks of resistance
training twice a week showed greater upregulation of messenger ribonucleic acid (mRNA)
levels of antioxidant enzymes such as catalase, GPX, and SOD compared to those who
underwent endurance training [89]. Chronic resistance training offers protection against
oxidative stress independent of training intensity. Both hypertrophy-intensity and strength-
intensity training have been found to result in similar reductions in malondialdehyde
levels and increases in glutathione levels in young men (aged 22.8 ± 2.7 years) [90]. These
results have also been demonstrated in young, trained individuals [91], older adults [92],
obese adults [93], and obese older women [94]. Sarcopenia, the age-related loss of muscle
mass, strength, and function, may be triggered by the accumulation of reactive oxygen
species (ROS), which cause oxidative stress and damage to cellular components, while
exercise can help to delay or prevent sarcopenia despite increasing mechanical damage and
accumulation of free radicals [95].
As a result, increasing evidence suggests that reactive oxygen species (ROS) may
function as crucial intracellular signaling molecules that promote adaptations induced by
resistance training (RT) to enhance cellular tolerance to future stress.

6. Reactive Oxygen Species, Antioxidants, and Inflammation

6.1. The Effect of Antioxidants on Reactive Oxygen Species in Physical Activity
Reactive oxygen species (ROS) are natural byproducts of cellular processes, especially
during aerobic metabolism, and play a significant role in cell signaling. However, an
imbalance between ROS generation and antioxidant presence can result in oxidative stress,
leading to cellular and tissue damage, and contributing to various pathological conditions,
including inflammation [96]. In recent years, antioxidant supplements have gained signifi-
cant attention as a non-invasive approach to mitigate muscle damage, enhance exercise
performance, prevent oxidative stress, improve lifespan and performance, and reduce the
risk of adverse health effects associated with intense exercise in athletes [97].
Achieving an optimal antioxidant status can be achieved by consuming sufficient
amounts of minerals and vitamins through a balanced and comprehensive diet that in-
cludes antioxidant-rich foods such as fruits, vegetables, and fiber. This approach ensures
that antioxidants are present in natural ratios and proportions that can synergistically
enhance their antioxidant effect [41,98–100]. Moreover, research has shown that quercetin
supplementation may have beneficial effects on inflammation, maximal aerobic capacity,
and fatigue during prolonged exercise in untrained but healthy individuals. A seven-day
course of quercetin supplementation led to a slight increase in VO2max and a significant
increase in ride time to fatigue, suggesting that quercetin may enhance endurance even
without exercise training, which could be advantageous for athletic and military perfor-
mance. Furthermore, the improvement in fitness without exercise training could have
broader implications for health promotion and disease prevention [101].
Multiple studies conducted worldwide have consistently shown that a diet rich
in vegetables, fruits, and legumes, which are abundant sources of antioxidants, is in-
versely related to inflammatory markers in the blood, including CRP, IL-6, and adhesion
factors [102,103]. These findings are supported by another study that investigated adoles-
cents aged 13–17 years and found that a diet rich in fruits and vegetables, which provide
antioxidants, folate, and flavonoids, was associated with reduced levels of inflammation
markers such as CRP, IL-6, and TNF-α [104]. Furthermore, a study reported that a
three-week intervention with a 300 mg/d anthocyanin extract from blueberries resulted
in a significant decrease in plasma concentrations of pro-inflammatory cytokines and
chemokines associated with NF-kB signaling pathway activation, including IL-4, IL-13,
IL-8, and IFN-a [105].

6.2. The Effect of Antioxidants on ROS and Inflammation in Sports

Altitude training is a common practice to enhance athletic performance by increasing
oxygen-carrying capacity, but it is also associated with increased oxidative stress and
Nutrients 2023, 15, 2371 12 of 35

inflammation. In a previous study, 31 elite endurance athletes were randomly divided

into two groups during a three-week-long altitude training camp at 2320 m. One group
consumed antioxidant-rich foods, while the control group consumed eucaloric foods. The
results showed that the consumption of antioxidant-rich foods increased the athletes’
antioxidant capacity and partially reduced systemic inflammatory biomarkers associated
with altitude training. However, the antioxidant intervention did not affect oxidative stress
induced by altitude training or acute cytokine responses to exercise stress tests [106].
In contrast, a different study investigating the effects of consuming flavonoid-rich
fresh fruit and vegetable juice on various biomarkers in elite sprint and middle-distance
swimmers reported different findings. The results showed no significant effect of consum-
ing juice for 10 days on chronic resting and post-exercise inflammation, oxidative stress,
immune function, and metabolic profiles, and no significant benefits were observed other
than an increase in nutrient intake [107].
The effects of different antioxidant supplements on exercise performance, antioxidant
capacity, inflammation, and immune changes have been investigated in several studies.
In one study, the influence of watermelon intake on exercise performance was studied in
cyclists. The results showed that watermelon consumption supported the energy demands
of exercise, increased post-exercise levels of nutritional components such as l-citrulline
and l-arginine, and improved antioxidant capacity and total nitrate levels. However, it did
not have a significant effect on post-exercise inflammation and innate immune function
changes [108].
Another study investigated the effects of natural pomegranate juice (POMj) supple-
mentation on performance and muscle soreness after weightlifting training sessions in elite
weightlifters. The study found that consuming POMj supplementation reduced acute and
delayed muscle soreness, inflammation, and damage, and improved the recovery kinetics
of biological parameters, ultimately leading to improved weightlifting performance [109].
The impact of antioxidant supplements on inflammation was also assessed during
intermittent shuttle running over a 6-week period in a study with 38 male participants.
The study found that combined vitamin C and E supplementation did not reduce markers
of oxidative stress or inflammation nor did it facilitate recovery of muscle function after
exercise-induced muscle damage [110]. Furthermore, a study investigated the effectiveness
of vitamin E and C supplementation in alleviating exercise-induced lipid peroxidation and
inflammation in runners during a 50 km ultramarathon. The findings showed that markers
of inflammation increased significantly in response to the run regardless of the treatment
group, although antioxidant supplementation was found to prevent endurance-exercise-
induced lipid peroxidation [111].
Finally, to assess the impact of a four-week course of antioxidant (AOX) supplementa-
tion on exercise-induced lipid peroxidation, muscle damage, and inflammation, kayakers
were randomly allocated to receive either a placebo or an AOX capsule in a study with
20 participants. The results suggested that AOX supplementation did not confer protection
against exercise-induced lipid peroxidation and inflammation and may impede muscle
recovery [112].
In general, the efficacy of antioxidant supplements in mitigating inflammation and
muscle damage and promoting recovery has yielded inconsistent outcomes due to dis-
crepancies in exercise regimens, study methodologies, and analytical approaches. Further
research is needed to better understand the role of antioxidants in exercise performance
and recovery.

7. Antioxidant Capacity and the Microbiota

The gut microbiota refers to a group of microorganisms that reside throughout the
gastrointestinal tract of mammals from the stomach to the colon. Its capacity is estimated
to hold 10ˆ14 cells (10 times the total number of cells in the human body), and yet, authors
describe it as a symbiotic super-organism made up of eukaryotic and prokaryotic cells [113].
Composed of 500–1000 different species, its composition is host-specific, evolving through-
Nutrients 2023, 15, 2371 13 of 35

out an individual’s life and influenced by both exogenous and endogenous factors. In this
line, its composition begins to form at birth and continues to evolve during lactation. Babies
delivered vaginally tend to have a more diverse microbiota dominated by Lactobacillus,
Prevotella, or Sneathia species, while those born by Cesarean have less diverse microbiota
with a predominance of Staphylococcus, Corynebacterium, and Propionibacterium. In
childhood, the microbiota adopts the composition of adulthood, in which only 7–9 phyla of
the total phyla that make up the Bacteria domain are represented. In the adult microbiota,
90% of the phylotypes belong to the Firmicutes (60–80%) and Bacteroidetes (15–30%) phyla,
while the other minority groups belong to Proteobacteria, Actinobacteria, Fusobacteria,
and Verrucomicrobia phyla [113].
Despite this chronic conformation, there are exogenous factors that can alter its compo-
sition, especially in adulthood. For example, stress and imbalanced diets are just two factors
that can modify the composition of the gut microbiota, leading to a state of dysbiosis that
may have negative effects on overall health [114]. Therefore, a stable and well-balanced gut
microbiota is necessary to be in a state of homeostasis, capable of maximizing the beneficial
interactions among its various members and with the host, which will help resist external
and internal influences [115].
Among the major factors shaping the composition of the gut microbiota, physical
activity and nutrition are two of them, with them influencing various mechanisms, such as
the release of hormones and the redirection of blood from the gut to the skeletal muscles.
In this line, the type, intensity, and duration of physical activity as well as the dietary
intake of micro and macronutrients have a potential effect on the gut microbial population,
ultimately altering its enzymatic potential and affecting the host’s overall health [116]. Yet,
nutrition is the most powerful modulator.
In this line, macronutrients would be related to the supply of energy and structural
support to the body, while micronutrients, such as vitamins, minerals, and other bioactive
compounds, regulate biochemical processes and safeguard against various illnesses. These
micronutrients play an important role in counteracting free radicals such as ROS and
RONS that cause oxidative stress [117]. Among them, carotenoids, polyphenols, ascorbic
acid, tocopherols, zinc, and selenium are present in food [118]; yet, supplementation
may be necessary, especially in athletes as seen before. In this line, recent studies have
shown that the gut microbiota, the microbes present in the intestine, are involved in
vital biological processes such as regulating the immune system, nutrient absorption,
and protecting against pathogens [119]. Interestingly, dietary antioxidants have been
observed to modulate gut microbes while these same microbes produce useful metabolites
by metabolizing the antioxidants. Thus, highlighting the importance and understanding of
the interactions between dietary substances and gut microbes to develop therapeutic and
preventive strategies targeting the gut microbiota is essential.
One of the most studied micronutrients is carotenoids, essential for humans because
they act as precursors to vitamin A. They can be found in carrots, spinach, corn, tomatoes,
and bell peppers, comprising compounds such as β-carotene, α-carotene, β-cryptoxanthin,
lutein, zeaxanthin, neoxanthin, capsanthin, bixin, and lycopene. The presence of conjugated
double bonds in carotenoids makes them act as antioxidants, which are a significant target
of free radicals. In this line, researchers have demonstrated that carotenoids have preventive
properties for cancer and several eye disorders, especially lutein and zeaxanthin [120].
Studies have shown that the consumption of β-carotene with other antioxidants such
as tocopherol and selenium can decrease mortality rates in stomach cancer [121]. Lycopene,
a vital antioxidant compound found in tomatoes, might cut the chance of upper aero-
digestive tract cancer [122]. Astaxanthin consumption could greatly improve the lipid
profile, leading to reduced low-density lipoprotein (LDL), cholesterol, and triglyceride
levels [123]. A few studies have explored the interaction of different types of carotenoids
with the gut microbiome. A study with a β-carotene oxygenase knockout mouse (C57BL/6
mice) model demonstrated that astaxanthin treatment significantly increased the popula-
tion of Mucispirillum schaedleri and Akkermansia muciniphila compared to wild-type
Nutrients 2023, 15, 2371 14 of 35

mice [124]. Similarly, in another pilot study, the administration of astaxanthin in the diet of
β-carotene oxygenase knockout mice altered the gut microbiota, which was different in both
genders of mice [125]. Studies on β-Carotene-15, 150 -oxygenase (BCO1)/β-carotene-90 , 100 -
oxygenase (BCO2) double knockout mice models revealed that a meal supplemented with
tomato powder boosted the prevalence of helpful microorganisms such as Lactobacillus
and Bifidobacterium [126].
Other antioxidants largely studied are polyphenols. These are aromatic molecules
consisting of phenolic rings and are further classified into various subgroups, including
flavonoids, phenolic acids, stilbenes, and lignans [127]. Major sources of polyphenols
are blueberries, raspberries, oranges, onions, soybeans, and green tea leaves. Over the
years, polyphenols have been the focus of several epidemiological cohort and case-control-
based studies to determine their effects on human health. Researchers suggest that a
polyphenol-rich diet may protect against chronic diseases such as cancer, cardiovascular
diseases, and inflammatory diseases [128]. Furthermore, there is a subgroup of polyphenols
called flavonoids, which can be classified into various types, including flavonols, flavones,
isoflavones, flavanones, anthocyanidins, and flavanols. These molecules exhibit pleiotropic
properties, including anti-inflammatory, antiallergenic, antiviral, neuroprotective, cardio-
protective, and chemoprotective properties [129]. Researchers have found that flavonoids
scavenge oxygen-free radicals or inhibit the enzyme responsible for producing ROS; thus,
the catechol group of flavonoids plays a crucial role in free radical scavenging and antioxi-
dant activity [130]. Furthermore, anthocyanins, another subgroup of flavonoids possess
significant antioxidant activity. Some of the different anthocyanins include delphinidin,
petunidin, malvidin, cyanidin, peonidin, and pelargonidin. Researchers attribute them to
anticancer, antimicrobial, and protective properties against cardiovascular diseases [131]. In
this line, studies have suggested the effectiveness of anthocyanin-rich diets in significantly
reducing fat accumulation in the body, and this could be possible because anthocyanins
attenuate the synthesis of lipids in adipose tissue and the liver [132]. Additionally, studies
have shown that consuming antioxidant-rich bilberry extracts significantly reduces blood
sugar and increases insulin sensitivity, which is crucial in diabetic conditions [133].
Polyphenols also interact with gut microbiomes, and gut microflora plays a vital
role in the metabolism of dietary polyphenols. Dietary polyphenols undergo conjugation
in the small intestine and are then sent to hepatocytes for phase I and II metabolisms.
Water-soluble conjugates of polyphenol molecules travel through the small intestine and
the systematic circulation to several organs and are finally excreted through urine. The
unabsorbed molecules undergo several enzymatic alterations such as hydrolysis, reduction,
dehydroxylation, decarboxylation, demethylation, and ring fission, mainly carried out by
gut microbes in the lumen of the large intestine [134]. Thus, their pleiotropic attributes
make them attractive agents for disease prevention and treatment. Their consumption in a
diet or throw supplementation may be a useful protection against various chronic diseases.
Yet, further research is necessary to determine the specific mechanisms of polyphenols in
promoting human health.
Another largely studied micronutrient with antioxidant properties is vitamin C, also
known as ascorbic acid. A water-soluble compound found in fruits such as oranges, lemons,
grapefruit, and guava, it plays many roles, including acting as an antioxidant, a cofactor for
enzymes, and supporting the immune system [135]. Indeed, it is essential since it regulates
various transcription factors and signaling cascades, especially those related to the immune
system and resistance against pathogens [136]. Its implication related to the gut microbiota
is that vitamin C is absorbed from the intestine and stored in cells as ascorbic acid. In
this line, pathogenic strains can decompose ascorbic acid, while some bacteria can reduce
dehydroascorbic acid to ascorbic acid. Thus, vitamin C can positively modulate the gut
microbiota and improve butyrate production, which contributes to restoring gut microbiota
homeostasis and immune balance in ethanol-induced liver injury [135].
Vitamin E is a compound that includes tocopherols and tocotrienols, which are classi-
fied into subgroups based on the placement of methyl groups. Vitamin E is found in wheat
Nutrients 2023, 15, 2371 15 of 35

germ oil, almonds, avocado, and various nuts [137]. Vitamin E has non-polar properties
and acts as an antioxidant, protecting against free radical activity. Consuming vitamin
E, along with vitamins C and carotene, can help protect against cardiovascular diseases.
Vitamin E also helps protect against neurodegenerative disorders and cognitive impair-
ment. Vitamin E facilitates the release of prostacyclin, which inhibits platelet aggregation
and provides defense against viral infection [138]. Vitamin E improves immune system
function and minimizes infection risk, especially in the elderly. Vitamin E interacts with gut
microbes, which could be the reason for the health benefits exhibited by vitamin E. Vitamin
E administration can modulate gut microbes and be helpful in colitis treatment. However,
an excess amount of vitamin E amendment can increase the population of pathogenic
bacteria, leading to various metabolic disorders [139].
Zinc is an essential mineral that plays a crucial role in human health. According to
the World Health Organization, zinc deficiency affects around 2 billion people and can
cause growth retardation, oxidative stress, and inflammation. Zinc is found in various
food sources, such as lean meat, eggs, seafood, beans, nuts, and chickpeas. Additionally,
zinc has been shown to be effective in treating diarrhea and reducing the duration of the
common cold. Zinc’s role in human health is multifaceted [140]. It competes with iron
and copper ions, restricting the development of free radicals that can damage cells. Zinc
also promotes the synthesis of antioxidant proteins and enzymes while inhibiting oxidant-
promoting enzymes, making it essential for maintaining a healthy immune system [141].
Supplementation of zinc in older adults has been found to reduce infections, and studies
have shown that zinc supplementation can reduce various oxidative stress markers in
plasma [142]. The interaction of zinc with the gut microbiome is an area of growing
interest. Studies have shown that dietary zinc has a modulatory effect on gut microbial
populations, with zinc-fortified diets increasing the population of beneficial microbes such
as Lactobacillus reuteri, Dorea, Clostridiales, Ruminococcus, and Lachnospiraceae [143].
However, some studies have shown that exposure to zinc can reduce the population of
beneficial gut microbes, such as Actinobacteria and Lactobacillus, and disturb the gut
microbial community [144].
In line with these micronutrients, lastly, we can find selenium, an essential trace ele-
ment required for the human body’s proper functioning [145]. This element is primarily
found in seafood, cereals, and dairy products. Research studies have shown that seleno-
proteins, which require selenium for their synthesis, are effective in reducing the oxidative
stress generated by ROS and RONS. Selenium deficiency leads to congestive cardiomy-
opathy, also known as Keshan disease [146]. However, selenium is proven to improve the
immune system, regulate thyroid hormones, and exhibit anticancer properties [147]. Apart
from the role of selenium in maintaining human health, its interaction with the gut micro-
biome is an emerging area of research. A recent study has demonstrated that gut microbes
play an active role in selenium metabolism [148]. Various microbes present in the human
gut require selenium to express their selenoproteins, and dietary selenium is primarily
found in two forms: Se-methionine and selenite [149]. The digestibility of Se-methionine is
higher than selenite, and the absorption and metabolism of Se-methionine occur through
the same pathways as methionine. Studies have shown that the gut microbiota-targeted
therapeutic diets with polysaccharides are effective in treating obesity and diabetes [150].
Selenium-rich Cordyceps militaris polysaccharides (Se-CMP) have been shown to decrease
serum LDL and increase beneficial gut bacteria such as Akkermansia [151]. Furthermore, a
selenium-rich diet has been shown to increase the richness and diversity of gut microbes
and increase beneficial microbial species such as Christensenellaceae, Ruminococcaceae,
and Lactobacillus [152]. The authors of the study also elucidated that the increase in glu-
tathione peroxidase and selenoalbumin after the administration of a selenium-rich diet
could be related to the positive changes in gut microflora. These findings suggest that
selenium and gut microbes have an active bi-directional interaction [153].
Nutrients 2023, 15, 2371 16 of 35

8. Antioxidants and Recovery from Training

Antioxidants play a crucial role in aiding an athlete’s recovery after training. During
exercise, there is increased release of free radicals and reactive oxygen species (ROS)
by the body, which can damage cells and cause oxidative stress in tissues [154]. This
rise in ROS has been established as a trigger for muscle damage (DOMS) and reduced
performance [155]. However, ROS is produced in various biological processes and can
signal the body’s response to physical activity for proper adaptations [156].
Despite the health benefits of physical activity, it can also lead to an increase in ox-
idative stress, resulting in higher production of free radicals and decreased antioxidant
defenses in the body [25]. High-intensity and eccentric exercises, in particular, have been
found to reduce antioxidant defenses and cause muscle damage, leading to DOMS [157].
However, recent studies have shown that ROS induced by physical exercise can also reg-
ulate enzymatic and non-enzymatic antioxidants in the body, protecting against cellular
oxidative damage and optimizing signaling for proper muscle adaptation [158]. Nev-
ertheless, intense physical exercise can also impact the immune and hormonal systems,
leading to increased levels of interleukin 6 (IL-6), creatine kinase (CK), glutamic oxaloacetic
transaminase (GOT), and glutamic-pyruvic transaminase (GPT) [159].
DOMS typically peaks between 24 to 72 h after a workout and gradually subsides
within 5 to 7 days [160]. As a result, athletes have had to adopt strategies to reduce acute
muscle damage and hasten recovery for subsequent training sessions. Among the various
recovery strategies, antioxidant supplementation has become a common practice among
athletes, as these molecules neutralize ROS and help prevent damage [161]. Ingesting
supplements or foods with a high antioxidant content in doses higher than the recom-
mended levels in the days leading up to sports competitions has been reported to prevent
or reduce DOMS [162]. Antioxidants are generally classified as exogenous (such as vitamin
C, vitamin E, polyphenols, glutathione, carotenoids, and coenzyme Q10) and endogenous
(including plasma proteins, bilirubin, uric acid, and the enzymes superoxide dismutase,
glutathione peroxidase, and catalase) [161]. Numerous studies have investigated the ef-
ficacy of antioxidants (from whole natural food sources, antioxidant extracts, or vitamin
C and E supplements, among others) in alleviating muscle pain and soreness in various
exercise modalities, yielding controversial results.
In the context of strength training, Ammar et al. [109] conducted a study that showed
an improvement in recovery from oxidative stress with pomegranate juice compared to
a placebo after two training sessions involving Olympic exercises (snatch, clean and jerk,
and squat). The authors observed a reduction in malondialdehyde (MDA), which is known
to have a significant effect on lipid peroxidation and antioxidant parameters. Similarly,
Leonardo-Mendoça et al. [163] found that the supplementation of 100 mg of melatonin
per day protected skeletal muscles against oxidative damage in well-trained athletes. This
was evident through a reduction in CK, lactate dehydrogenase (LDH), creatinine, and total
cholesterol levels after 4 weeks of consumption compared to the placebo.
In another study, melatonin supplementation of 20 mg per day during two weeks of
high-intensity interval training (HIIT) and strength training showed improved antioxidant
status in highly trained athletes. This was reflected in increased melatonin levels and
glutathione peroxidase activity, as well as reduced muscle DNA damage [164]. Moreover,
Stefan et al. [165] observed an improvement in perceived muscle recovery and a reduction in
serum CK levels after 5 weeks of full-body training exercises in both males and females aged
21 to 65 years following L-carnitine supplementation. Regarding vitamin supplementation,
Silva et al. [166] demonstrated that vitamin E supplementation at a dose of 800 IU of D-α-
tocopherol acetate per day for 21 days resulted in significantly lower levels of muscular
damage and oxidative stress compared to the control group. This was assessed after
three sets of flexion and extension of the elbow on the Scott bench at 2 min intervals until
exhaustion. However, there was no significant difference in the inflammatory response
(TNF-α and IL-10) between the two groups. Furthermore, de Oliveira et al. [167] reported
that antioxidant vitamin supplementation effectively prevented oxidative stress in soccer
Nutrients 2023, 15, 2371 17 of 35

athletes through a reduction in malondialdehyde lipid peroxidation, total lipid peroxidation,

and the ratio of glutathione to oxidized glutathione after consumption of VitC (500 mg) and
VitE (400 IU of α-tocopherol) per day for 15 days. However, this vitamin supplementation
did not significantly reduce the plasma CK concentration or DOMS during the recovery
days after an acute bout of plyometric jump and strength resistance set to exhaustion.
Despite this, a recent systematic review [159] established that adequate supplementation
with antioxidants can help reduce the oxidative stress generated by resistance training.
In the context of aerobic training, Zhang et al. [168] conducted a study that showed the
positive effects of oats on the body. They found that a daily dose of 20 mg of oats reduced
circulatory inflammatory cytokines and CK levels after 8 weeks of downhill running (10%
grade with an intensity equivalent to 75% of their maximal heart rate) in active participants.
Similarly, Drobnic et al. [169] observed a decrease in interleukin 8 (IL-8) values, resulting
in reduced muscular trauma and moderate pain in the posterior and medial thigh after a
downhill run (test on a treadmill at grade -10% at a constant speed with an intensity of
aerobic threshold for 45 min), following the consumption of 200 mg of curcumin twice a
day for 5 days prior to the test. Another study by He et al. [170] showed that an antioxidant
supplement (100 mg vitamin C and 400 IU vitamin E ingested daily for 2 weeks) reduced
muscle soreness in the quadriceps and tibialis anterior, as well as CK levels, and increased
activity and oxygen radical absorbance capacity after the first bout of exercise (40 min of
downhill running at −10% grade at 65% to 70% VO2max). However, these parameters
were not significantly different between the antioxidant and placebo groups in a second
session, indicating that antioxidant supplementation did not prevent the adaptation that
occurs with repeated sessions. On the other hand, Close et al. [171] found that ascorbic
acid supplementation (1.5 g of ascorbic acid daily for three days before and two days after
the trial) did not reduce muscle soreness compared to the placebo group after a bout of
exercise designed to cause muscle damage (downhill running on a motorized treadmill
for 30 min). However, elevated serum MDA levels were reported in the placebo group
only after 72 and 96 h post exercise. Similarly, Kashef et al. [172] showed that vitamin E
supplementation (400 IU per day for 30 days) had no significant effect on the development
of DOMS in young men after 10 min of bench leg step ups with both legs. There were no
significant differences between the vitamin E and placebo groups in terms of VAS scores
and CK and CRP levels.
Despite the findings mentioned above, different reviews with meta-analyses have
concluded that there is little evidence to support the use of antioxidants for preventing or
reducing muscle soreness after exercise [161,173,174]. This is because the recovery process is
a complex phenomenon that can be influenced by many variables, such as differences in the
antioxidant dosage, the length of supplementation, the type of participants, or differences
in size, body weight, and body composition, which may result in different responses
to antioxidant supplementation. Therefore, further research is needed to confirm these
findings and investigate the potential long-term effects of antioxidant supplementation on
exercise recovery against acute effects.

9. The Effect of an Antioxidant Diet on Sports Performance

Exercise-induced oxidative stress can lead to muscle damage, impaired performance,
and fatigue. During exercise, there is an increase in oxygen consumption, resulting in the
production of reactive oxygen species (ROS) [154]. These ROS can cause damage to cells
and tissues, leading to oxidative stress. As a result, oxidative stress plays a role in the
development of fatigue and may impair performance in athletes. However, antioxidants,
which are compounds that can neutralize free radicals and reduce oxidative stress, can
have a positive impact on athletic performance. Several studies have examined the impact
of antioxidants on various aspects of sports performance, such as endurance, strength,
and recovery [96]. Despite some suggestions in the scientific community that certain an-
tioxidants may have a positive impact on athletic performance, the evidence is not strong
enough to make specific recommendations for athletes [174]. Therefore, implementing an
Nutrients 2023, 15, 2371 18 of 35

antioxidant-rich diet may reduce oxidative stress and improve exercise performance in this
population. However, the optimal dose, duration, and timing of antioxidant supplementa-
tion remain unclear, and more research is needed to determine the potential benefits and
risks of antioxidant supplementation for athletes [161].
One simple and effective way to maintain an antioxidant status that helps reduce
the oxidative stress generated by physical exercise is through the addition of foods rich
in antioxidants to a balanced diet, such as the Mediterranean diet [175]. Adhering to a
Mediterranean-style diet has been shown to enhance antioxidant defenses, improve lipid
profile, and reduce LDL oxidation more than a high-fat diet [11]. However, there have been
limited studies conducted to specifically examine the antioxidant effects of a particular diet
on sports performance.
Therefore, while some evidence suggests that an antioxidant-rich diet may positively
impact athletic performance, further research is needed to establish clear recommendations
for athletes. It is important to consider various factors such as the type of antioxidant,
dosage, duration of supplementation, and timing in relation to exercise, as well as individ-
ual differences in size, body weight, and body composition that may influence the response
to antioxidant supplementation. In conclusion, while antioxidants may have potential
benefits for athletes, more research is needed to fully understand their effects on sports
performance and recovery.
In the context of antioxidant-rich diets, various studies have investigated the ef-
fects of specific antioxidant compounds on athletic performance. For instance, Gómez-
Cabrera et al. [72] found that vitamin C supplementation (1 g/day) led to a smaller increase
in muscle mitochondrial biogenesis and a smaller improvement in endurance performance
compared to placebo after an 8-week supervised resistance training program on a cycle
ergometer. However, Braakhuis et al. [176] reported that blackcurrant (BC) juice (15 mg
VC, 300 mg anthocyanins) slightly increased the maximum running speed in an incremen-
tal trial more than vitamin C (1 g) alone and the placebo after 3 weeks of high-intensity
training. Similarly, Aguiló et al. [177] demonstrated that 90 days of supplementation with
antioxidants (500 mg/day of vitamin E, 30 mg/day of β-carotene, and 1 g/day of vitamin
C in the last 15 days) resulted in a significant improvement in aerobic performance (7.2%
increase in VO2 max) and a lower peak blood lactate concentration compared to the placebo
group after a maximal exercise test on a cycle ergometer. However, Paulsen et al. [178]
reported that vitamin C and E supplements (1000 mg and 235 mg for 11 weeks, respectively)
had less improvement in endurance performance compared to the placebo, suggesting
that high doses of vitamins may interfere with cellular adaptations that occur in response
to endurance training, particularly in the muscles (Table 1). Hence, athletes should be
cautious about high doses of antioxidant supplements, as they may potentially decrease
performance, as reported in various studies [96].
In the case of quercetin, Daneshvar et al. [179] showed that supplementation with
1000 mg of quercetin per day for eight weeks resulted in significant improvements in
exercise performance (a 5.2% increase in cycle time in an incremental trial) compared to the
placebo in male badminton players. Similarly, MacRae et al. [180] found that a combination
of quercetin and antioxidant supplements led to a significant improvement in cycling time
trial performance compared to the placebo, quercetin alone, or isolated antioxidants in elite
male cyclists. However, Darvishi et al. [181] reported no significant difference in swim
performance or body composition between the quercetin supplementation group (1000 mg)
and the placebo group in female swimmers. Additionally, the supplementation of 1000 mg
of quercetin per day for 1 week did not show significant differences in VO2 max and race
time relative to the placebo in the untrained participants [182].
In relation to resveratrol, there have been limited studies conducted in human models
compared to animal models, and the effects of this supplement on performance parameters
remain controversial [11]. For instance, Gliemann et al. [183] found that exercise training
combined with resveratrol supplementation (250 mg per week for 8 weeks) did not result
in the same magnitude of improvement in performance and health parameters (such as
Nutrients 2023, 15, 2371 19 of 35

maximal oxygen uptake, blood pressure, and cholesterol levels) as exercise alone in elderly
untrained males.

Table 1. Summary of the main antioxidants together with their physiological function, their effect on
sports performance, and the scientific evidence.

Antioxidant Physiological Function Effect on Sports Performance Scientific Evidence

Helps protect cells from oxidative
Vitamin C damage and improves iron
absorption
Protects cell membranes from
Vitamin E
oxidative damage
Anti-inflammatory, antidiabetic,
Quercetin antioxidant, anti-infective, and
cardioprotective effects
Neuroprotective and
Resveratrol
cardioprotective effects
Hemodynamic (vasodilator) and
Beetroot juice (nitric
metabolic functions (promotes
oxide)
oxygen transfer in the muscle)
Cellular energy production,
antioxidant protection, regulation
Coenzyme Q10 of the immune system, and
improvement of cardiovascular and
cognitive function
Strengthening the immune system,
Spirulina lowering cholesterol, and
regulating blood sugar
Enhances the production of
Polyphenols
vasodilating factors and blood flow
Possible improvement in aerobic
Small
capacity
Possible improvement in aerobic
Small
capacity
Improvement in exercise capacity
(VO2 max and endurance exercise Small
performance)
May improve endurance capacity
Small
and skeletal muscle strength
Improves cardiorespiratory
performance at the anaerobic Medium
threshold and VO2 max intensities
Possible improvement in aerobic
Small
capacity
Possible improvement in oxygen
uptake and exercise tolerance at Small
submaximal intensities
Enhancement of vascular function,
muscle perfusion, and oxygen Small
extraction during exercise

As for beetroot juice, Wylie et al. [184] reported that supplementation with 140 mL of
beetroot juice resulted in significant increases in plasma nitrite levels compared to a placebo.
Moreover, beetroot juice also led to a significant increase in power output during the last
10 min of an incremental cycle ergometer test in young men. Similarly, Lansley et al. [185]
investigated the effect of beetroot juice consumed 2.5 h prior to completing a 4 km cycling
time trial in elite male cyclists. The authors found that the cyclists completed the time
trial significantly faster after consuming the beetroot juice supplement compared to the
placebo supplement. The average power output during the time trial was also significantly
higher after consuming the beetroot juice supplement. Furthermore, Wylie et al. [186]
demonstrated that the group consuming nitrate-rich beetroot juice (280 mL per day for
2 days) had significantly improved performance compared to the placebo group. Specifically,
the nitrate supplementation led to an increase in the distance covered in a Yo-Yo Intermittent
Recovery Level 1 test in team sport players. However, Hoon et al. [187] reported in their
meta-analysis that nitrate supplementation might have a beneficial effect in non-athletes but
concluded that athletes do not respond to this supplementation.

10. The Effect of Antioxidant Supplementation on Sports Performance

Antioxidant supplementation has been widely used in sports to improve performance
and prevent cell and tissue damage caused by oxidative stress during intense exercise [13].
During intense exercise, there is an increase in free radical production, which can contribute
to muscle damage and fatigue [188]. Antioxidant supplementation may help counteract
this effect by neutralizing free radicals and protecting cells and tissues. However, the results
Nutrients 2023, 15, 2371 20 of 35

of studies in this area are mixed and inconclusive, with some sports showing benefits in
antioxidant capacity and a reduction in muscle damage and inflammation, while others do
not [188].
One of the most extensively studied antioxidants is vitamin C. Vitamin C supplemen-
tation has been suggested to improve athletic performance due to its antioxidant effects, its
ability to regenerate other antioxidants, and its potential to improve immune function [13].
Some studies have found that vitamin C supplementation may improve antioxidant capac-
ity, reduce muscle damage, and reduce inflammation in athletes [12]. However, the results
are mixed and further studies are needed to fully assess the effect of vitamin C supplemen-
tation on exercise performance. For example, one study concluded that vitamin C may
have a positive antioxidant effect but does not directly improve athletic performance in
marathon runners [176]. Similarly, it has been shown that vitamin C supplementation does
not improve performance in terms of race time or speed in long-distance cyclists. However,
cyclists who took vitamin C experienced a significant reduction in muscle damage and
inflammation after exercise [189]. On the other hand, vitamin C supplementation has been
found to significantly reduce muscle damage and inflammation after exercise and may help
improve muscle recovery after intense exercise [12].
Vitamin E supplementation may also be an effective strategy for improving athletic
performance and reducing the oxidative stress associated with intense exercise. Vitamin E
acts as an antioxidant, reducing oxidative damage to muscle cells and improving immune
function and the regulation of lipid metabolism [190]. Overall, vitamin E supplementation
appears to have a beneficial effect on exercise performance by reducing oxidative stress and
muscle damage after exercise [13]. However, the results are mixed and further studies are
needed to determine the exact effects of vitamin E supplementation in different sports and
populations. For example, a meta-analysis of 22 trials found that vitamin E supplementation
significantly improved exercise performance compared to a placebo [191]. Vitamin E
supplementation was also associated with a reduction in inflammation and soreness after
exercise [191]. In a study of endurance athletes, vitamin E supplementation for 8 weeks
significantly increased antioxidant capacity and reduced muscle damage after exercise [72].
Another study in cyclists found that vitamin E supplementation for 4 weeks improved
performance in an endurance test [192]. However, some studies have found no significant
benefit of vitamin E supplementation on exercise performance, such as a study of football
players which found no significant differences in performance after 8 weeks of vitamin E
supplementation [193]. Table 2 shows the content of vitamin E in some foods.
There are several polyphenolic compounds found in various foods that have been
studied for their potential effects on athletic performance. Resveratrol, found in grapes,
blueberries, and peanuts, acts as an antioxidant, reducing oxidative damage to muscle cells
and improving mitochondrial function, which is crucial for energy production and muscle
function [194]. Some studies suggest that resveratrol supplementation may have beneficial
effects on athletic performance by improving antioxidant capacity and reducing muscle
damage, although the results may not be consistent across all studies or sports [195]. For
example, a study in rats found that resveratrol supplementation improved performance
in a swimming test and reduced oxidative stress in muscles [196], while another study in
humans found that resveratrol supplementation improved plasma antioxidant capacity
and reduced muscle damage after high-intensity exercise [197]. However, other studies
have found no significant effect of resveratrol supplementation on exercise performance,
such as one study of elite cyclists that found no improvement in a long-duration endurance
test [198] and another study in football players that found no significant effect on physical
or cognitive performance [199].
CoQ10, another compound with potential performance-enhancing effects, may im-
prove athletic performance due to its antioxidant and energetic properties. CoQ10 plays
a role in the mitochondrial electron transport chain, and studies suggest that supplemen-
tation may improve exercise capacity, reduce oxidative stress, shorten running time, and
improve muscle recovery in athletes [195]. For example, a study of marathon runners found
Nutrients 2023, 15, 2371 21 of 35

that CoQ10 supplementation reduced muscle damage and improved plasma antioxidant
capacity after the race [200], and another study of elite cyclists found that CoQ10 supple-
mentation improved performance in a long-duration endurance test [201]. In addition to
its antioxidant effects, CoQ10 has also been proposed to enhance athletic performance by
improving mitochondrial function and energy production. A pilot study of swimmers
showed that CoQ10 supplementation improved energy efficiency during exercise and
reduced muscle fatigue [202]. However, other studies have found no significant effect of
CoQ10 supplementation on exercise performance, such as one study of swimmers that
found no significant difference in performance after 18 sessions of CoQ10 supplementa-
tion [203], and another study in cyclists that found no significant effect on performance
during a short endurance event [204,205].

Table 2. Antioxidant content in food.

Selenium
Vitamin E (mg/100 g) Vitamin C (mg/100 g) Vitamin A (mcg/100 g) Zinc (mg/100 g)
(mcg/100 g)
Sunflower oil 55 Kiwi 500 Animal vetches 5800 Cooked oysters 37 Brazil nuts 1917
Maize oil 31 Guava 480 Sorrel 2100 Wheat germ 12.2 Pork kidneys 311
Wheat germ 30 Red pepper 204 Carrots 2000 Hemp seeds 9.9 Lamb 218
Hazelnuts 26 Red currant 200 Spinach (cooked) 1000 Roast beef 8.5 Eggs 192
Almonds 25 Parsley 150 Parsley 1160 Almonds 5 Oysters 154
Coconut 17 Persimmon 130 Butter 970 Peanuts 4.8 Veal 141
Cooked veal
Corn germ 16 Brussels sprouts 100 Sweet potatoes 670 4.5 Turkey 144
liver
Soybean oil 14 Lemon 80 Soybean oil 583 Cooked turkey 4.5 Mustard seed 208
Soya bean Fresh and frozen Sunflower
13 Cauliflower 70 450 Cooked veal 4.4 78.2
sprouts tuna and bonito seeds
Cooked
Olive oil 12 Spinach 60 Cheese 240 4.3 Garlic 14.2
chicken liver
Margarine 10 Strawberry 60 Eggs 220 Cooked crab 4.3
Peanuts 9 Orange 50 Other vegetables 130 Cooked lamb 4

Selenium, as a cofactor for glutathione peroxidase and its role in protein synthesis and
the immune response, has been studied for its potential effects on athletic performance.
While there is evidence to suggest that selenium supplementation may have beneficial an-
tioxidant effects in the body, which could help improve the antioxidant response and reduce
muscle damage and inflammation after intense exercise, there is no conclusive evidence that
selenium supplementation directly improves exercise performance [206]. For example, one
study showed that selenium supplementation improved antioxidant response in endurance
athletes but did not result in significant improvements in performance [174], while another
study showed improved thyroid function and antioxidant response in endurance athletes,
but no significant improvements in exercise performance [207]. A recent study demon-
strated improved muscle recovery after intense exercise through reduced muscle damage
and inflammation [206]. However, more research is needed to determine the long-term
effects of selenium supplementation on exercise performance and overall health.
Curcumin, known for its antioxidant effects and its potential to improve mitochondrial
function and ATP production, has also been studied for its effects on athletic performance.
Studies suggest that curcumin supplementation may improve exercise capacity, reduce
oxidative stress, and reduce exercise-induced muscle soreness in athletes [208]. For ex-
ample, one study showed that curcumin supplementation significantly reduced levels of
muscle damage and inflammation after endurance exercise in young men, suggesting an
antioxidant and anti-inflammatory effect [209]. Another study demonstrated that curcumin
supplementation improved performance in terms of the distance covered and time taken
during endurance exercise in cyclists compared to a placebo [169]. Furthermore, another
Nutrients 2023, 15, 2371 22 of 35

study showed that curcumin supplementation significantly reduced levels of muscle dam-
age and inflammation after endurance exercise in young women, indicating its potential
antioxidant and anti-inflammatory effects. Additionally, curcumin supplementation was
found to significantly improve performance in terms of time spent during endurance
exercise when compared to a placebo [210].
In general, antioxidants such as vitamin C, vitamin E, resveratrol, coenzyme Q10,
selenium, and curcumin have been shown to have positive effects on health and exercise
performance. These antioxidants can help reduce inflammation, protect cells from oxidative
damage, and improve muscle recovery after intense exercise. However, the specific effects
may vary depending on the type of exercise, the dose and duration of supplementation,
and individual characteristics. It is important to note that antioxidant supplementation
should not replace a balanced diet and adequate hydration. Additionally, antioxidant sup-
plementation should be individualized and supervised by a health professional, especially
in people with chronic diseases or who are taking other medications.

11. Key Points and Strategies for Antioxidant Supplementation in Sports Competitions
11.1. Vitamin C
Vitamin C supplementation is widely used among athletes due to its antioxidant
effects and potential to improve muscle recovery after intense exercise. The recommended
dose of vitamin C for athletes varies depending on the duration and intensity of exercise.
Typically, a daily dose of 500 to 2000 mg of vitamin C is recommended for maintaining good
health and reducing oxidative stress. However, some studies suggest that higher doses (up
to 3 g/day) may be beneficial for athletes who engage in intense and prolonged exercise,
such as marathons, to prevent muscle damage and improve recovery [178]. Research also
suggests that the timing of vitamin C supplementation may play a role in its effectiveness.
Pre-exercise vitamin C supplementation has been shown to reduce exercise-induced muscle
damage and inflammation [72]. On the other hand, post-exercise vitamin C supplemen-
tation may improve muscle recovery and reduce soreness [171]. The duration of vitamin
C treatment in athletes varies based on training goals and individual needs. Generally, it
is recommended to take vitamin C continuously for several weeks prior to competition
to reduce oxidative stress and improve muscle recovery. Some studies suggest that vita-
min C supplementation for 4–6 weeks prior to competition may enhance performance in
high-intensity, short-duration exercise [176].
In conclusion, vitamin C supplementation in athletes may be beneficial in reducing
oxidative stress and improving muscle recovery after intense exercise. Recommended
doses may vary depending on the duration and intensity of exercise, and the timing
of supplementation, either before or after exercise, may influence its effectiveness. The
duration of treatment should be tailored according to training goals and individual needs.
It is important to consult with a healthcare professional for personalized recommendations
and to closely monitor for any potential side effects.

11.2. Vitamin E
Vitamin E supplementation in athletes has been studied for its potential effect in
preventing exercise-induced muscle damage and improving athletic performance. The
recommended dose of vitamin E supplementation for athletes varies depending on the
duration and intensity of exercise and should not exceed 1000 IU per day to avoid possible
adverse effects, such as reducing the body’s ability to clot blood. Vitamin E supplements can
be taken before and after exercise. In one study, athletes were given 400 IU of vitamin E for
5 days before long-distance running, and supplementation was found to reduce the amount
of DNA and protein oxidation products in skeletal muscle after exercise [211]. In another
study, a single dose of 800 IU of vitamin E was given to subjects 30 min before endurance
exercise, and a significant reduction in the levels of markers of muscle damage was observed
compared with the placebo group [212]. The duration of vitamin E supplementation varies
from study to study, with athletes receiving 400 IU of vitamin E for 5 days in one study [211],
Nutrients 2023, 15, 2371 23 of 35

while in another study, a single dose of 800 IU of vitamin E was administered [212]. In
conclusion, vitamin E supplementation may have beneficial effects in preventing exercise-
induced muscle damage and improving athletic performance in athletes. However, the
recommended dose of vitamin E supplementation varies according to the duration and
intensity of exercise, and care should be taken not to exceed 1000 IU per day to avoid
potential adverse effects. In addition, the duration of supplementation also varies from
study to study, although it is generally recommended that vitamin E supplementation
should be acute rather than chronic. More research is needed to better understand the role
of vitamin E in health and exercise performance.

11.3. Resveratrol
Resveratrol is a polyphenol found in certain foods such as grapes, blueberries, and
walnuts and has been studied for its potential to improve athletic performance through
its antioxidant and anti-inflammatory effects. The recommended dose of resveratrol for
improving athletic performance varies from study to study, but a daily dose of 250–500 mg
has generally been used [213]. Resveratrol supplementation has been used in both the
pre-competition and recovery phases. The duration of supplementation with resveratrol to
improve athletic performance varies from study to study, but generally a duration of four to
eight weeks has been used [214]. In conclusion, resveratrol supplementation may improve
athletic performance through its antioxidant and anti-inflammatory effects. A daily dose
of 250–500 mg is recommended for four to eight weeks, both in the pre-competition and
recovery phases. However, further studies are needed to confirm these effects and to
determine the optimal dose and duration of resveratrol supplementation in athletes.

11.4. Coenzyme Q10

CoQ10 supplementation has been shown to have positive effects on cardiovascular
function, brain health, and antioxidant protection. Some studies have also investigated its
potential effects on exercise performance in athletes. The recommended dose of CoQ10
varies from study to study, but a daily dose of 100–300 mg has generally been used to
improve performance in athletes [215]. CoQ10 supplementation has been used in both
the pre-competition and recovery phases and has been shown to be effective in both
phases [215]. The duration of treatment also varies from study to study, but generally a
duration of 4–12 weeks has been used [215]. A study investigated the effects of CoQ10
supplementation in elite Japanese kendo athletes. The participants were given 300 mg of
CoQ10 daily for 20 days. Significant reductions in muscle damage and improvements in
performance were observed compared to the control group [216]. Another study looked at
the effects of CoQ10 supplementation in untrained males and females. The participants
were given 100 mg of CoQ10 daily for 14 days before undergoing different tests [201].
Significant improvements in time to exhaustion and reductions in muscle damage were
observed compared to the control group.
In conclusion, CoQ10 supplementation may improve athletic performance and reduce
muscle damage. The recommended dose varies from study to study, but generally a daily
dose of 100–300 mg for 4–12 weeks has been used, and supplementation can be taken in
both the pre-competition and recovery phases.

11.5. Selenium
Selenium is an essential trace element for human health and plays an important
role in the body’s antioxidant function. Selenium supplementation has been shown to
improve general health and may have specific benefits for athletes. The recommended dose
of selenium for athletes varies from study to study, but a daily dose of 200–400 mcg has
generally been used. A recent systematic review and meta-analysis concluded that selenium
supplementation at doses between 100–400 mcg/day may improve athletic performance in
terms of aerobic capacity and muscle strength [206]. Selenium supplementation has been
administered at various times, including before exercise, during exercise, and after exercise.
Nutrients 2023, 15, 2371 24 of 35

The duration of selenium treatment also varies from trial to trial, but generally 4–12 weeks
has been used. In general, selenium supplementation can be beneficial for athletes, but it is
important to note that excess selenium can be toxic. It is recommended that daily doses do
not exceed 400 mcg to avoid potential adverse effects [217].

11.6. Curcumin
Curcumin, a bioactive compound found in turmeric, has been extensively studied for
its anti-inflammatory and antioxidant properties, making it a potential athletic-performance-
enhancing supplement. The recommended dosage of curcumin for athletes varies depend-
ing on the purpose of supplementation. To reduce muscle soreness and improve recovery,
doses of 400–500 mg of curcumin twice daily have been used. To improve athletic perfor-
mance, doses of 90–500 mg of curcumin per day have been used [208]. Its supplementation
can be taken either before or after exercise. Pre-exercise supplementation has been shown
to reduce exercise-induced muscle inflammation and soreness [169]. Post-exercise supple-
mentation may improve muscle recovery and reduce muscle soreness [218]. The duration
of curcumin supplementation depends on the purpose of the supplementation. For re-
ducing muscle soreness and improving recovery, treatments of 4–12 weeks have been
used. Treatments of 2–8 weeks have been used to improve athletic performance [208]. In
this line, a study investigated the effects of curcumin supplementation in women with
moderate physical activity levels. The participants received 500 mg/day of curcumin
for 8 weeks, and a significant reduction in muscle soreness and improved recovery was
observed compared to the placebo group [219]. Another study investigated the effects of
curcumin supplementation in healthy, moderately active men. The participants received
200 mg of curcumin twice daily for 2 days before and 1 day after an eccentric muscle injury
protocol. A significant reduction in levels of inflammatory markers and muscle soreness
was observed compared to the placebo group [169].
In conclusion, curcumin supplementation may be beneficial in reducing muscle soreness,
improving recovery, and possibly improving athletic performance in athletes. Recommended
doses vary depending on the purpose of supplementation, but doses of 400–500 mg twice daily
have been used to reduce muscle soreness and improve recovery, and doses of 90–500 mg
daily have been used to improve exercise performance. Supplementation can be taken either
before or after exercise, and the duration of treatment varies depending on the purpose of
supplementation, but 4–12-week courses have been used to reduce muscle soreness and
improve recovery, and 2–8-week courses have been used to improve sports performance.

11.7. Omega-3
Omega-3 fatty acids, particularly eicosapentaenoic acid (EPA) and docosahexaenoic
acid (DHA), are known for their anti-inflammatory and antioxidant properties, making
them a potential supplement for athletes. Oxidative stress, which occurs when there is an
imbalance between the production of reactive oxygen species (ROS) and the body’s ability
to remove them, can negatively impact athletic performance and recovery. Omega-3s can
help reduce oxidative stress in athletes, thereby improving their performance and recovery.
The recommended dose of omega-3s for athletes varies between 1 and 5 g per day of
EPA and DHA combined, with a daily dose of 3 g appearing to be effective in reducing
inflammation and oxidative stress in athletes [220]. Omega-3 supplementation can be used
both in the pre-competition phase and in the recovery phase. A study showed that omega-3
supplementation for 6 weeks prior to an endurance event improved performance and
reduced inflammation [221]. The duration of omega-3 supplementation varies between
4 and 12 weeks, depending on the study and the purpose of the supplementation, with
4 weeks of supplementation generally being sufficient to improve recovery and reduce
oxidative stress in athletes [220].
In general, omega-3 supplementation may be an effective strategy to reduce oxidative
stress in athletes and improve their performance and recovery, with a daily dose of 3 g
of EPA and DHA combined for 4 weeks appearing to be sufficient to provide significant
Nutrients 2023, 15, 2371 25 of 35

benefits. However, it is important to note that, as with any supplement, consulting a health
professional before starting omega-3 supplementation is recommended.

11.8. Zinc
Zinc, an essential micronutrient, plays a crucial role in maintaining good health and
athletic performance. It acts as an antioxidant by neutralizing free radicals and reducing
oxidative stress. Zinc also regulates the immune system and protein synthesis, which can
aid in muscle recovery after intense exercise. The recommended dose of zinc for athletes
varies depending on the type of sport and the duration and intensity of exercise. Studies
have shown that a daily dose of 15–30 mg of zinc can improve antioxidant status and
reduce oxidative stress in athletes [222]. However, higher doses may not be beneficial and
can have adverse health effects, such as immune system suppression and reduced nutrient
absorption [223]. The timing of supplementation may also be important, with some studies
suggesting that pre-exercise supplementation may be more effective in reducing oxidative
stress compared to during or after exercise [222]. Additionally, the duration of treatment
may play a role, as zinc supplementation for at least 4–6 weeks has been shown to improve
antioxidant status in athletes [224].
In conclusion, zinc supplementation may have beneficial effects in reducing oxidative
stress and improving exercise performance under certain conditions [222]. Effective doses
vary among studies, but generally, daily doses of 15–30 mg of zinc have been used. Pre-
exercise supplementation appears to be more effective, although the optimal duration of
treatment is still being researched, with varying ranges of 4–12 weeks. It is important
to note that excessive zinc supplementation can be toxic, and it is recommended not to
exceed the recommended daily intake of 40 mg. Therefore, finding the balance between an
effective dose and a toxic dose should be considered when supplementing zinc in athletes.

11.9. Glutathione
Glutathione, an endogenous antioxidant produced by the body and found in various
cells, including skeletal muscle cells, has been studied for its effects on oxidative stress and
exercise performance. Interestingly, the effective dose of glutathione appears to depend
on the method of administration. In one study, oral supplementation with 450 mg of glu-
tathione per day for 3 weeks improved antioxidant status [225]. On the other hand, another
study showed that intravenous administration of a single acute dose of 3000 mg/day of
glutathione improved total antioxidant capacity [226]. Additionally, a study using a daily
dose of 1000 mg for three weeks found a reduction in serum levels of oxidative stress mark-
ers [227]. However, more studies are needed to determine the optimal dose of glutathione
to improve athletic performance and reduce oxidative stress.
The timing of glutathione supplementation may also be important, but evidence
suggests that it can be taken acutely or chronically (up to 4–6 weeks) [225]. Further
studies are needed to determine the optimal duration of glutathione supplementation.
Moreover, more research is required to investigate the different types of glutathione and
their absorption and bioavailability in the body.
In general, while glutathione supplementation has shown some beneficial effects in
reducing oxidative stress and improving athletic performance, the results are inconsistent,
and more research is needed to determine the effective dose, the timing of supplementation,
and the duration of treatment. It is important to continue studying glutathione supplemen-
tation to better understand its potential benefits for athletes. Similarly, N-acetylcysteine
(NAC) has been used as a precursor of glutathione to potentially enhance performance
in elite sports, but concerns about its side effects with high doses have been raised [228].
The scientific literature suggests that NAC supplementation in the range of 1.2–20 g/day,
whether taken acutely or over several weeks, can produce performance effects that vary
from beneficial to trivial or even detrimental, and the true performance effect of NAC
remains unclear. Additionally, the extent to which NAC may cause side effects is not fully
understood, although doses greater than 5 g may be associated with more side effects than
Nutrients 2023, 15, 2371 26 of 35

doses less than 2 g. Therefore, further research on NAC supplementation and its effects on
athletic performance is needed before definitive conclusions can be made [228].
In general terms, it has been observed that supplementation with combinations of
antioxidants can be effective in improving antioxidant protection and reducing oxidative
stress in athletes and the general population, potentially leading to improved athletic
performance [229,230]. However, it is important to note that the effects may vary depending
on the type of sport and the level of training, and it is recommended to consult a healthcare
professional before starting any type of supplementation [231–233].

12. Practical Applications

This review provides valuable insights for the practical application of sports perfor-
mance and understanding the actions of supplements that attenuate and regulate the effects
of reactive oxygen species (ROS). Specifically, it helps to comprehend performance from
a holistic perspective, including microbiology and the relationship between antioxidant
capacity and the microbiota, as well as the potential benefits of an antioxidant-rich diet and
antioxidant supplementation for sports performance. As such, this review may lead to the
implementation of new working methods and dietary protocols in sports teams aiming to
improve performance.

13. Conclusions
There is growing evidence suggesting that ROS production during physical activity
greatly influences sports performance. This review concludes that ROS plays a critical
role in the processes of training adaptation induced by resistance training, through a
reduction in inflammatory mediators and oxidative stress, as well as appropriate molecular
signaling. Additionally, it has been established that micronutrients play an important
role in counteracting free radicals, such as reactive oxygen species, which cause oxidative
stress, and the effects of antioxidants on recovery, sports performance, and strategies for
using antioxidant supplements, such as vitamin C, vitamin E, resveratrol, coenzyme Q10,
selenium, and curcumin, to enhance physical and mental well-being.

Author Contributions: Conceptualization, V.J.C.-S.; methodology, J.F.T.-A.; investigation, all authors;

writing—original draft preparation, all authors; writing—review and editing, all authors; visualiza-
tion, all authors; supervision, V.J.C.-S.; project administration, V.J.C.-S. All authors have read and
agreed to the published version of the manuscript.
Funding: This research received no external funding.
Institutional Review Board Statement: Not applicable.
Informed Consent Statement: Not applicable.
Data Availability Statement: Not applicable.
Conflicts of Interest: The authors declare no conflict of interest.

References
1. Pisoschi, A.M.; Pop, A. The Role of Antioxidants in the Chemistry of Oxidative Stress: A Review. Eur. J. Med. Chem. 2015, 97,
55–74. [CrossRef]
2. Pan, M.; Liu, K.; Yang, J.; Liu, S.; Wang, S.; Wang, S. Advances on Food-Derived Peptidic Antioxidants—A Review. Antioxidants
2020, 9, 799. [CrossRef]
3. Clarkson, P.M. Antioxidants and Physical Performance. Crit. Rev. Food Sci. Nutr. 1995, 35, 131–141. [CrossRef]
4. De Sousa, C.V.; Sales, M.M.; Rosa, T.S.; Lewis, J.E.; de Andrade, R.V.; Simões, H.G. The Antioxidant Effect of Exercise: A
Systematic Review and Meta-Analysis. Sports Med. 2017, 47, 277–293. [CrossRef]
5. McClean, C.; Davison, G.W. Circadian Clocks, Redox Homeostasis, and Exercise: Time to Connect the Dots? Antioxidants 2022, 11,
256. [CrossRef]
6. Li, S.; Fasipe, B.; Laher, I. Potential Harms of Supplementation with High Doses of Antioxidants in Athletes. J. Exerc. Sci. Fit.
2022, 20, 269–275. [CrossRef]
7. Novel Training and Other Strategies for Sport Performance at the 2011 ACSM Annual Meeting. Available online: http://www.
sportsci.org/2011/wghACSM.htm (accessed on 3 April 2023).
Nutrients 2023, 15, 2371 27 of 35

8. Bustamante-Sanchez, A.; Villegas-Mora, B.E.; Martínez-Guardado, I.; Tornero-Aguilera, J.F.; Ardigò, L.P.; Nobari, H.; Clemente-
Suárez, V.J. Physical Activity and Nutritional Pattern Related to Maturation and Development. Sustainability 2022, 14, 16958.
[CrossRef]
9. Margaritelis, N.V.; Paschalis, V.; Theodorou, A.A.; Kyparos, A.; Nikolaidis, M.G. Redox Basis of Exercise Physiology. Redox Biol.
2020, 35, 101499. [CrossRef]
10. Williamson, J.; Davison, G. Targeted Antioxidants in Exercise-Induced Mitochondrial Oxidative Stress: Emphasis on DNA
Damage. Antioxidants 2020, 9, 1142. [CrossRef]
11. Braakhuis, A.J.; Hopkins, W.G. Impact of Dietary Antioxidants on Sport Performance: A Review. Sports Med. 2015, 45, 939–955.
[CrossRef]
12. Righi, N.C.; Schuch, F.B.; De Nardi, A.T.; Pippi, C.M.; de Almeida Righi, G.; Puntel, G.O.; da Silva, A.M.V.; Signori, L.U. Effects
of Vitamin C on Oxidative Stress, Inflammation, Muscle Soreness, and Strength Following Acute Exercise: Meta-Analyses of
Randomized Clinical Trials. Eur. J. Nutr. 2020, 59, 2827–2839. [CrossRef]
13. Higgins, M.R.; Izadi, A.; Kaviani, M. Antioxidants and Exercise Performance: With a Focus on Vitamin E and C Supplementation.
Int. J. Env. Res. Public. Health 2020, 17, 8452. [CrossRef]
14. Elejalde, E.; Villarán, M.C.; Alonso, R.M. Grape Polyphenols Supplementation for Exercise-Induced Oxidative Stress. J. Int. Soc.
Sports Nutr. 2021, 18, 3. [CrossRef]
15. Harper, S.A.; Bassler, J.R.; Peramsetty, S.; Yang, Y.; Roberts, L.M.; Drummer, D.; Mankowski, R.T.; Leeuwenburgh, C.; Ricart, K.;
Patel, R.P.; et al. Resveratrol and Exercise Combined to Treat Functional Limitations in Late Life: A Pilot Randomized Controlled
Trial. Exp. Gerontol. 2021, 143, 111111. [CrossRef]
16. Jones, L.; Bailey, S.J.; Rowland, S.N.; Alsharif, N.; Shannon, O.M.; Clifford, T. The Effect of Nitrate-Rich Beetroot Juice on Markers
of Exercise-Induced Muscle Damage: A Systematic Review and Meta-Analysis of Human Intervention Trials. J. Diet. Suppl. 2022,
19, 749–771. [CrossRef]
17. Antioxidant, Anti-Inflammatory and Immunomodulatory Effects of Spirulina in Exercise and Sport: A Systematic Review—
PubMed. Available online: https://pubmed.ncbi.nlm.nih.gov/36590230/ (accessed on 3 April 2023).
18. Mason, S.A.; Trewin, A.J.; Parker, L.; Wadley, G.D. Antioxidant Supplements and Endurance Exercise: Current Evidence and
Mechanistic Insights. Redox Biol. 2020, 35, 101471. [CrossRef]
19. Steinbacher, P.; Eckl, P. Impact of Oxidative Stress on Exercising Skeletal Muscle. Biomolecules 2015, 5, 356–377. [CrossRef]
20. Sakellariou, G.K.; Vasilaki, A.; Palomero, J.; Kayani, A.; Zibrik, L.; McArdle, A.; Jackson, M.J. Studies of Mitochondrial and
Nonmitochondrial Sources Implicate Nicotinamide Adenine Dinucleotide Phosphate Oxidase(s) in the Increased Skeletal Muscle
Superoxide Generation That Occurs during Contractile Activity. Antioxid. Redox Signal. 2013, 18, 603–621. [CrossRef]
21. He, F.; Li, J.; Liu, Z.; Chuang, C.-C.; Yang, W.; Zuo, L. Redox Mechanism of Reactive Oxygen Species in Exercise. Front. Physiol.
2016, 7, 486. [CrossRef]
22. Gomez-Cabrera, M.C.; Close, G.L.; Kayani, A.; McArdle, A.; Viña, J.; Jackson, M.J. Effect of Xanthine Oxidase-Generated
Extracellular Superoxide on Skeletal Muscle Force Generation. Am. J. Physiol. Regul. Integr. Comp. Physiol. 2010, 298, R2-8.
[CrossRef]
23. Russell, E.G.; Cotter, T.G. New Insight into the Role of Reactive Oxygen Species (ROS) in Cellular Signal-Transduction Processes.
Int. Rev. Cell Mol. Biol. 2015, 319, 221–254. [CrossRef]
24. Alfadda, A.A.; Sallam, R.M. Reactive Oxygen Species in Health and Disease. J. Biomed. Biotechnol. 2012, 2012, 936486. [CrossRef]
25. Powers, S.K.; Jackson, M.J. Exercise-Induced Oxidative Stress: Cellular Mechanisms and Impact on Muscle Force Production.
Physiol. Rev. 2008, 88, 1243–1276. [CrossRef]
26. Wiegman, C.H.; Michaeloudes, C.; Haji, G.; Narang, P.; Clarke, C.J.; Russell, K.E.; Bao, W.; Pavlidis, S.; Barnes, P.J.; Kanerva, J.;
et al. Oxidative Stress-Induced Mitochondrial Dysfunction Drives Inflammation and Airway Smooth Muscle Remodeling in
Patients with Chronic Obstructive Pulmonary Disease. J. Allergy Clin. Immunol. 2015, 136, 769–780. [CrossRef]
27. Brooks, G.A. The Science and Translation of Lactate Shuttle Theory. Cell Metab. 2018, 27, 757–785. [CrossRef]
28. Iatsenko, I.; Boquete, J.-P.; Lemaitre, B. Microbiota-Derived Lactate Activates Production of Reactive Oxygen Species by the
Intestinal NADPH Oxidase Nox and Shortens Drosophila Lifespan. Immunity 2018, 49, 929–942.e5. [CrossRef]
29. Specht, K.S.; Kant, S.; Addington, A.K.; McMillan, R.P.; Hulver, M.W.; Learnard, H.; Campbell, M.; Donnelly, S.R.; Caliz, A.D.; Pei,
Y.; et al. Nox4 Mediates Skeletal Muscle Metabolic Responses to Exercise. Mol. Metab. 2021, 45, 101160. [CrossRef]
30. Zuo, L.; Zhou, T.; Pannell, B.K.; Ziegler, A.C.; Best, T.M. Biological and Physiological Role of Reactive Oxygen Species–the Good,
the Bad and the Ugly. Acta Physiol. 2015, 214, 329–348. [CrossRef]
31. Hidalgo, C.; Sánchez, G.; Barrientos, G.; Aracena-Parks, P. A Transverse Tubule NADPH Oxidase Activity Stimulates Calcium
Release from Isolated Triads via Ryanodine Receptor Type 1 S -Glutathionylation. J. Biol. Chem. 2006, 281, 26473–26482. [CrossRef]
32. Powers, S.K.; Ji, L.L.; Kavazis, A.N.; Jackson, M.J. Reactive Oxygen Species: Impact on Skeletal Muscle. Compr. Physiol. 2011, 1,
941–969. [CrossRef]
33. Powers, S.K.; Schrager, M. Redox Signaling Regulates Skeletal Muscle Remodeling in Response to Exercise and Prolonged
Inactivity. Redox Biol. 2022, 54, 102374. [CrossRef]
34. Bouviere, J.; Fortunato, R.S.; Dupuy, C.; Werneck-de-Castro, J.P.; Carvalho, D.P.; Louzada, R.A. Exercise-Stimulated ROS Sensitive
Signaling Pathways in Skeletal Muscle. Antioxidants 2021, 10, 537. [CrossRef]
Nutrients 2023, 15, 2371 28 of 35

35. Yavari, A.; Javadi, M.; Mirmiran, P.; Bahadoran, Z. Exercise-Induced Oxidative Stress and Dietary Antioxidants. Asian J. Sports
Med. 2015, 6, e24898. [CrossRef]
36. Muthusamy, V.R.; Kannan, S.; Sadhaasivam, K.; Gounder, S.S.; Davidson, C.J.; Boeheme, C.; Hoidal, J.R.; Wang, L.; Rajasekaran,
N.S. Acute Exercise Stress Activates Nrf2/ARE Signaling and Promotes Antioxidant Mechanisms in the Myocardium. Free Radic.
Biol. Med. 2012, 52, 366–376. [CrossRef]
37. Akimoto, T.; Pohnert, S.C.; Li, P.; Zhang, M.; Gumbs, C.; Rosenberg, P.B.; Williams, R.S.; Yan, Z. Exercise Stimulates Pgc-1alpha
Transcription in Skeletal Muscle through Activation of the P38 MAPK Pathway. J. Biol. Chem. 2005, 280, 19587–19593. [CrossRef]
38. Jäger, S.; Handschin, C.; St-Pierre, J.; Spiegelman, B.M. AMP-Activated Protein Kinase (AMPK) Action in Skeletal Muscle via
Direct Phosphorylation of PGC-1alpha. Proc. Natl. Acad. Sci. USA 2007, 104, 12017–12022. [CrossRef]
39. Espinosa, A.; Leiva, A.; Peña, M.; Müller, M.; Debandi, A.; Hidalgo, C.; Carrasco, M.A.; Jaimovich, E. Myotube Depolarization
Generates Reactive Oxygen Species through NAD(P)H Oxidase; ROS-Elicited Ca2+ Stimulates ERK, CREB, Early Genes. J. Cell.
Physiol. 2006, 209, 379–388. [CrossRef]
40. Ruas, J.L.; White, J.P.; Rao, R.R.; Kleiner, S.; Brannan, K.T.; Harrison, B.C.; Greene, N.P.; Wu, J.; Estall, J.L.; Irving, B.A.; et al. A
PGC-1α Isoform Induced by Resistance Training Regulates Skeletal Muscle Hypertrophy. Cell 2012, 151, 1319–1331. [CrossRef]
41. Morales-Alamo, D.; Calbet, J.A.L. Free Radicals and Sprint Exercise in Humans. Free Radic. Res. 2014, 48, 30–42. [CrossRef]
42. Kang, C.; O’Moore, K.M.; Dickman, J.R.; Ji, L.L. Exercise Activation of Muscle Peroxisome Proliferator-Activated Receptor-Gamma
Coactivator-1alpha Signaling Is Redox Sensitive. Free Radic. Biol. Med. 2009, 47, 1394–1400. [CrossRef]
43. Low, I.C.C.; Loh, T.; Huang, Y.; Virshup, D.M.; Pervaiz, S. Ser70 Phosphorylation of Bcl-2 by Selective Tyrosine Nitration of
PP2A-B56δ Stabilizes Its Antiapoptotic Activity. Blood 2014, 124, 2223–2234. [CrossRef]
44. Thirupathi, A.; Wang, M.; Lin, J.K.; Fekete, G.; István, B.; Baker, J.S.; Gu, Y. Effect of Different Exercise Modalities on Oxidative
Stress: A Systematic Review. Biomed. Res. Int. 2021, 2021, 1947928. [CrossRef]
45. Orlando, P.; Silvestri, S.; Galeazzi, R.; Antonicelli, R.; Marcheggiani, F.; Cirilli, I.; Bacchetti, T.; Tiano, L. Effect of Ubiquinol
Supplementation on Biochemical and Oxidative Stress Indexes after Intense Exercise in Young Athletes. Redox Rep. 2018, 23,
136–145. [CrossRef]
46. Nikolaidis, M.G.; Jamurtas, A.Z.; Paschalis, V.; Fatouros, I.G.; Koutedakis, Y.; Kouretas, D. The Effect of Muscle-Damaging
Exercise on Blood and Skeletal Muscle Oxidative Stress: Magnitude and Time-Course Considerations. Sports Med. 2008, 38,
579–606. [CrossRef]
47. Di Meo, S.; Napolitano, G.; Venditti, P. Mediators of Physical Activity Protection against ROS-Linked Skeletal Muscle Damage.
Int. J. Mol. Sci. 2019, 20, 3024. [CrossRef]
48. Sawada, Y.; Ichikawa, H.; Ebine, N.; Minamiyama, Y.; Alharbi, A.A.D.; Iwamoto, N.; Fukuoka, Y. Effects of High-Intensity
Anaerobic Exercise on the Scavenging Activity of Various Reactive Oxygen Species and Free Radicals in Athletes. Nutrients 2023,
15, 222. [CrossRef]
49. Bors, W.; Michel, C.; Saran, M.; Lengfelder, E. The Involvement of Oxygen Radicals during the Autoxidation of Adrenalin.
Biochim. Biophys. Acta 1978, 540, 162–172. [CrossRef]
50. Halliwell, B.; Gutteridge, J.M.C. Oxidative Stress and Redox Regulation: Adaptation, Damage, Repair, Senescence, and Death. In
Free Radicals in Biology and Medicine; Halliwell, B., Gutteridge, J.M.C., Eds.; Oxford University Press: Oxford, UK, 2015; ISBN
978-0-19-871747-8.
51. Powers, S.K.; Deminice, R.; Ozdemir, M.; Yoshihara, T.; Bomkamp, M.P.; Hyatt, H. Exercise-Induced Oxidative Stress: Friend or
Foe? J. Sport Health Sci. 2020, 9, 415–425. [CrossRef]
52. Henríquez-Olguín, C.; Renani, L.B.; Arab-Ceschia, L.; Raun, S.H.; Bhatia, A.; Li, Z.; Knudsen, J.R.; Holmdahl, R.; Jensen, T.E.
Adaptations to High-Intensity Interval Training in Skeletal Muscle Require NADPH Oxidase 2. Redox Biol. 2019, 24, 101188.
[CrossRef]
53. Radak, Z.; Suzuki, K.; Higuchi, M.; Balogh, L.; Boldogh, I.; Koltai, E. Physical Exercise, Reactive Oxygen Species and Neuroprotec-
tion. Free Radic. Biol. Med. 2016, 98, 187–196. [CrossRef]
54. Miyata, M.; Kasai, H.; Kawai, K.; Yamada, N.; Tokudome, M.; Ichikawa, H.; Goto, C.; Tokudome, Y.; Kuriki, K.; Hoshino,
H.; et al. Changes of Urinary 8-Hydroxydeoxyguanosine Levels during a Two-Day Ultramarathon Race Period in Japanese
Non-Professional Runners. Int. J. Sports Med. 2008, 29, 27–33. [CrossRef]
55. Azizbeigi, K.; Stannard, S.R.; Atashak, S.; Mosalman Haghighi, M. Antioxidant Enzymes and Oxidative Stress Adaptation to
Exercise Training: Comparison of Endurance, Resistance, and Concurrent Training in Untrained Males. J. Exerc. Sci. Fit. 2014, 12,
1–6. [CrossRef]
56. Hattori, N.; Hayashi, T.; Nakachi, K.; Ichikawa, H.; Goto, C.; Tokudome, Y.; Kuriki, K.; Hoshino, H.; Shibata, K.; Yamada, N.; et al.
Changes of ROS during a Two-Day Ultra-Marathon Race. Int. J. Sports Med. 2009, 30, 426–429. [CrossRef]
57. Belinchón-Demiguel, P.; Clemente-Suárez, V.J. Nutrition, hydration and ergogenic aids strategies in ultraendurance mountain
events. J. Sports Med. Phys. Fit. 2019, 59, 791–797. [CrossRef]
58. Close, G.L.; Ashton, T.; Cable, T.; Doran, D.; MacLaren, D.P.M. Eccentric Exercise, Isokinetic Muscle Torque and Delayed Onset
Muscle Soreness: The Role of Reactive Oxygen Species. Eur. J. Appl. Physiol. 2004, 91, 615–621. [CrossRef]
59. Miller, L.E.; McGinnis, G.R.; Kliszczewicz, B.; Slivka, D.; Hailes, W.; Cuddy, J.; Dumke, C.; Ruby, B.; Quindry, J.C. Blood
Oxidative-Stress Markers during a High-Altitude Trek. Int. J. Sport Nutr. Exerc. Metab. 2013, 23, 65–72. [CrossRef]
Nutrients 2023, 15, 2371 29 of 35

60. Siques, P.; Brito, J.; Pena, E. Reactive Oxygen Species and Pulmonary Vasculature During Hypobaric Hypoxia. Front. Physiol.
2018, 9, 865. [CrossRef]
61. Gaur, P.; Prasad, S.; Kumar, B.; Sharma, S.K.; Vats, P. High-Altitude Hypoxia Induced Reactive Oxygen Species Generation,
Signaling, and Mitigation Approaches. Int. J. Biometeorol. 2021, 65, 601–615. [CrossRef]
62. Jackson, M.J.; Pye, D.; Palomero, J. The Production of Reactive Oxygen and Nitrogen Species by Skeletal Muscle. J. Appl. Physiol.
2007, 102, 1664–1670. [CrossRef]
63. Urso, M.L.; Clarkson, P.M. Oxidative Stress, Exercise, and Antioxidant Supplementation. Toxicology 2003, 189, 41–54. [CrossRef]
64. Rabinovitch, R.C.; Samborska, B.; Faubert, B.; Ma, E.H.; Gravel, S.-P.; Andrzejewski, S.; Raissi, T.C.; Pause, A.; St-Pierre, J.; Jones,
R.G. AMPK Maintains Cellular Metabolic Homeostasis through Regulation of Mitochondrial Reactive Oxygen Species. Cell Rep.
2017, 21, 1–9. [CrossRef] [PubMed]
65. Brand, M.D.; Affourtit, C.; Esteves, T.C.; Green, K.; Lambert, A.J.; Miwa, S.; Pakay, J.L.; Parker, N. Mitochondrial Superoxide:
Production, Biological Effects, and Activation of Uncoupling Proteins. Free. Radic. Biol. Med. 2004, 37, 755–767. [CrossRef]
[PubMed]
66. Di Meo, S.; Venditti, P. Mitochondria in Exercise-Induced Oxidative Stress. Biol. Signals Recept. 2001, 10, 125–140. [CrossRef]
[PubMed]
67. Kozlov, A.V.; Szalay, L.; Umar, F.; Kropik, K.; Staniek, K.; Niedermüller, H.; Bahrami, S.; Nohl, H. Skeletal Muscles, Heart, and
Lung Are the Main Sources of Oxygen Radicals in Old Rats. Biochim. Biophys. Acta 2005, 1740, 382–389. [CrossRef]
68. Fittipaldi, S.; Dimauro, I.; Mercatelli, N.; Caporossi, D. Role of Exercise-Induced Reactive Oxygen Species in the Modulation of
Heat Shock Protein Response. Free. Radic. Res. 2014, 48, 52–70. [CrossRef]
69. Fisher-Wellman, K.; Bloomer, R.J. Acute Exercise and Oxidative Stress: A 30 Year History. Dyn. Med. 2009, 8, 1. [CrossRef]
70. Powers, S.K.; Nelson, W.B.; Hudson, M.B. Exercise-Induced Oxidative Stress in Humans: Cause and Consequences. Free Radic.
Biol. Med. 2011, 51, 942–950. [CrossRef]
71. St-Pierre, J.; Drori, S.; Uldry, M.; Silvaggi, J.M.; Rhee, J.; Jäger, S.; Handschin, C.; Zheng, K.; Lin, J.; Yang, W.; et al. Suppression of
Reactive Oxygen Species and Neurodegeneration by the PGC-1 Transcriptional Coactivators. Cell 2006, 127, 397–408. [CrossRef]
72. Gomez-Cabrera, M.-C.; Domenech, E.; Romagnoli, M.; Arduini, A.; Borras, C.; Pallardo, F.V.; Sastre, J.; Viña, J. Oral Administration
of Vitamin C Decreases Muscle Mitochondrial Biogenesis and Hampers Training-Induced Adaptations in Endurance Performance.
Am. J. Clin. Nutr. 2008, 87, 142–149. [CrossRef]
73. Ristow, M.; Zarse, K.; Oberbach, A.; Klöting, N.; Birringer, M.; Kiehntopf, M.; Stumvoll, M.; Kahn, C.R.; Blüher, M. Antioxidants
Prevent Health-Promoting Effects of Physical Exercise in Humans. Proc. Natl. Acad. Sci. USA 2009, 106, 8665–8670. [CrossRef]
74. Yfanti, C.; Akerström, T.; Nielsen, S.; Nielsen, A.R.; Mounier, R.; Mortensen, O.H.; Lykkesfeldt, J.; Rose, A.J.; Fischer, C.P.;
Pedersen, B.K. Antioxidant Supplementation Does Not Alter Endurance Training Adaptation. Med. Sci. Sports Exerc. 2010, 42,
1388–1395. [CrossRef]
75. Effect of Antioxidant Supplementation on Insulin Sensitivity in Response to Endurance Exercise Training—PubMed. Available
online: https://pubmed.ncbi.nlm.nih.gov/21325105/ (accessed on 3 April 2023).
76. Strobel, N.A.; Peake, J.M.; Matsumoto, A.; Marsh, S.A.; Coombes, J.S.; Wadley, G.D. Antioxidant Supplementation Reduces
Skeletal Muscle Mitochondrial Biogenesis. Med. Sci. Sports Exerc. 2011, 43, 1017–1024. [CrossRef]
77. Holloszy, J.O. Regulation by Exercise of Skeletal Muscle Content of Mitochondria and GLUT4. J. Physiol. Pharm. 2008, 59 (Suppl.
S7), 5–18.
78. Powers, S.K.; Talbert, E.E.; Adhihetty, P.J. Reactive Oxygen and Nitrogen Species as Intracellular Signals in Skeletal Muscle. J.
Physiol. 2011, 589, 2129–2138. [CrossRef]
79. Sahlin, K.; Shabalina, I.G.; Mattsson, C.M.; Bakkman, L.; Fernström, M.; Rozhdestvenskaya, Z.; Enqvist, J.K.; Nedergaard, J.;
Ekblom, B.; Tonkonogi, M. Ultraendurance Exercise Increases the Production of Reactive Oxygen Species in Isolated Mitochondria
from Human Skeletal Muscle. J. Appl. Physiol. 2010, 108, 780–787. [CrossRef]
80. Powers, S.K.; Smuder, A.J.; Kavazis, A.N.; Hudson, M.B. Experimental Guidelines for Studies Designed to Investigate the Impact
of Antioxidant Supplementation on Exercise Performance. Int. J. Sport Nutr. Exerc. Metab. 2010, 20, 2–14. [CrossRef]
81. Hood, D.A.; Irrcher, I.; Ljubicic, V.; Joseph, A.-M. Coordination of Metabolic Plasticity in Skeletal Muscle. J. Exp. Biol. 2006, 209,
2265–2275. [CrossRef]
82. Murgia, M.; Jensen, T.E.; Cusinato, M.; Garcia, M.; Richter, E.A.; Schiaffino, S. Multiple Signalling Pathways Redundantly Control
Glucose Transporter GLUT4 Gene Transcription in Skeletal Muscle. J. Physiol. 2009, 587, 4319–4327. [CrossRef]
83. Merry, T.L.; Ristow, M. Do Antioxidant Supplements Interfere with Skeletal Muscle Adaptation to Exercise Training? J. Physiol.
2016, 594, 5135–5147. [CrossRef]
84. Niki, E. Oxidative Stress and Antioxidants: Distress or Eustress? Arch. Biochem. Biophys. 2016, 595, 19–24. [CrossRef]
85. Trachootham, D.; Lu, W.; Ogasawara, M.A.; Valle, N.R.-D.; Huang, P. Redox Regulation of Cell Survival. Antioxid. Redox Signal.
2008, 10, 1343–1374. [CrossRef] [PubMed]
86. Sies, H. Oxidative Stress: A Concept in Redox Biology and Medicine. Redox Biol. 2015, 4, 180–183. [CrossRef] [PubMed]
87. Moylan, J.S.; Reid, M.B. Oxidative Stress, Chronic Disease, and Muscle Wasting. Muscle Nerve 2007, 35, 411–429. [CrossRef]
[PubMed]
88. Khansari, N.; Shakiba, Y.; Mahmoudi, M. Chronic Inflammation and Oxidative Stress as a Major Cause of Age-Related Diseases
and Cancer. Recent. Pat. Inflamm. Allergy Drug. Discov. 2009, 3, 73–80. [CrossRef]
Nutrients 2023, 15, 2371 30 of 35

89. García-López, D.; Häkkinen, K.; Cuevas, M.J.; Lima, E.; Kauhanen, A.; Mattila, M.; Sillanpää, E.; Ahtiainen, J.P.; Karavirta,
L.; Almar, M.; et al. Effects of Strength and Endurance Training on Antioxidant Enzyme Gene Expression and Activity in
Middle-Aged Men. Scand. J. Med. Sci. Sports 2007, 17, 595–604. [CrossRef]
90. Cakir-Atabek, H.; Demir, S.; PinarbaŞili, R.D.; Gündüz, N. Effects of Different Resistance Training Intensity on Indices of Oxidative
Stress. J. Strength. Cond. Res. 2010, 24, 2491–2497. [CrossRef]
91. Park, S.-Y.; Kwak, Y.-S. Impact of Aerobic and Anaerobic Exercise Training on Oxidative Stress and Antioxidant Defense in
Athletes. J. Exerc. Rehabil. 2016, 12, 113–117. [CrossRef]
92. Parise, G.; Phillips, S.M.; Kaczor, J.J.; Tarnopolsky, M.A. Antioxidant Enzyme Activity Is Up-Regulated after Unilateral Resistance
Exercise Training in Older Adults. Free Radic. Biol. Med. 2005, 39, 289–295. [CrossRef]
93. Vincent, K.R.; Vincent, H.K.; Braith, R.W.; Lennon, S.L.; Lowenthal, D.T. Resistance Exercise Training Attenuates Exercise-Induced
Lipid Peroxidation in the Elderly. Eur. J. Appl. Physiol. 2002, 87, 416–423. [CrossRef]
94. Padilha, C.S.; Ribeiro, A.S.; Fleck, S.J.; Nascimento, M.A.; Pina, F.L.C.; Okino, A.M.; Venturini, D.; Barbosa, D.S.; Mayhew, J.L.;
Cyrino, E.S. Effect of Resistance Training with Different Frequencies and Detraining on Muscular Strength and Oxidative Stress
Biomarkers in Older Women. Age 2015, 37, 104. [CrossRef]
95. Giorgi, C.; Marchi, S.; Simoes, I.C.M.; Ren, Z.; Morciano, G.; Perrone, M.; Patalas-Krawczyk, P.; Borchard, S.; J˛edrak, P.;
Pierzynowska, K.; et al. Mitochondria and Reactive Oxygen Species in Aging and Age-Related Diseases. Int. Rev. Cell Mol. Biol.
2018, 340, 209–344. [CrossRef]
96. Pingitore, A.; Lima, G.P.P.; Mastorci, F.; Quinones, A.; Iervasi, G.; Vassalle, C. Exercise and Oxidative Stress: Potential Effects of
Antioxidant Dietary Strategies in Sports. Nutrition 2015, 31, 916–922. [CrossRef]
97. Brisswalter, J.; Louis, J. Vitamin Supplementation Benefits in Master Athletes. Sports Med. 2014, 44, 311–318. [CrossRef]
98. Milan, S.J.; Hart, A.; Wilkinson, M. Vitamin C for Asthma and Exercise-Induced Bronchoconstriction. Cochrane Database Syst. Rev.
2013, 2013, CD010391. [CrossRef]
99. Myburgh, K.H. Polyphenol Supplementation: Benefits for Exercise Performance or Oxidative Stress? Sports Med. 2014, 44,
S57–S70. [CrossRef]
100. Dato, S.; Crocco, P.; D’Aquila, P.; de Rango, F.; Bellizzi, D.; Rose, G.; Passarino, G. Exploring the Role of Genetic Variability and
Lifestyle in Oxidative Stress Response for Healthy Aging and Longevity. Int. J. Mol. Sci. 2013, 14, 16443–16472. [CrossRef]
101. Cureton, K.J.; Tomporowski, P.D.; Singhal, A.; Pasley, J.D.; Bigelman, K.A.; Lambourne, K.; Trilk, J.L.; McCully, K.K.; Arnaud,
M.J.; Zhao, Q. Dietary Quercetin Supplementation Is Not Ergogenic in Untrained Men. J. Appl. Physiol. 2009, 107, 1095–1104.
[CrossRef]
102. Nanri, A.; Yoshida, D.; Yamaji, T.; Mizoue, T.; Takayanagi, R.; Kono, S. Dietary Patterns and C-Reactive Protein in Japanese Men
and Women. Am. J. Clin. Nutr. 2008, 87, 1488–1496. [CrossRef]
103. Salas-Salvadó, J.; Garcia-Arellano, A.; Estruch, R.; Marquez-Sandoval, F.; Corella, D.; Fiol, M.; Gómez-Gracia, E.; Viñoles, E.; Arós,
F.; Herrera, C.; et al. Components of the Mediterranean-Type Food Pattern and Serum Inflammatory Markers among Patients at
High Risk for Cardiovascular Disease. Eur. J. Clin. Nutr. 2008, 62, 651–659. [CrossRef]
104. Holt, E.M.; Steffen, L.M.; Moran, A.; Basu, S.; Steinberger, J.; Ross, J.A.; Hong, C.-P.; Sinaiko, A.R. Fruit and Vegetable Consumption
and Its Relation to Markers of Inflammation and Oxidative Stress in Adolescents. J. Am. Diet. Assoc. 2009, 109, 414–421. [CrossRef]
105. Karlsen, A.; Retterstøl, L.; Laake, P.; Paur, I.; Bøhn, S.K.; Sandvik, L.; Blomhoff, R. Anthocyanins Inhibit Nuclear Factor-KappaB
Activation in Monocytes and Reduce Plasma Concentrations of pro-Inflammatory Mediators in Healthy Adults. J. Nutr. 2007, 137,
1951–1954. [CrossRef] [PubMed]
106. Koivisto, A.E.; Olsen, T.; Paur, I.; Paulsen, G.; Bastani, N.E.; Garthe, I.; Raastad, T.; Matthews, J.; Blomhoff, R.; Bøhn, S.K. Effects of
Antioxidant-Rich Foods on Altitude-Induced Oxidative Stress and Inflammation in Elite Endurance Athletes: A Randomized
Controlled Trial. PLoS ONE 2019, 14, e0217895. [CrossRef] [PubMed]
107. Knab, A.M.; Nieman, D.C.; Gillitt, N.D.; Shanely, R.A.; Cialdella-Kam, L.; Henson, D.A.; Sha, W. Effects of a Flavonoid-Rich Juice
on Inflammation, Oxidative Stress, and Immunity in Elite Swimmers: A Metabolomics-Based Approach. Int. J. Sport Nutr. Exerc.
Metab. 2013, 23, 150–160. [CrossRef] [PubMed]
108. Shanely, R.A.; Nieman, D.C.; Perkins-Veazie, P.; Henson, D.A.; Meaney, M.P.; Knab, A.M.; Cialdell-Kam, L. Comparison of
Watermelon and Carbohydrate Beverage on Exercise-Induced Alterations in Systemic Inflammation, Immune Dysfunction, and
Plasma Antioxidant Capacity. Nutrients 2016, 8, 518. [CrossRef] [PubMed]
109. Ammar, A.; Turki, M.; Chtourou, H.; Hammouda, O.; Trabelsi, K.; Kallel, C.; Abdelkarim, O.; Hoekelmann, A.; Bouaziz, M.;
Ayadi, F.; et al. Pomegranate Supplementation Accelerates Recovery of Muscle Damage and Soreness and Inflammatory Markers
after a Weightlifting Training Session. PLoS ONE 2016, 11, e0160305. [CrossRef]
110. Bailey, D.M.; Williams, C.; Betts, J.A.; Thompson, D.; Hurst, T.L. Oxidative Stress, Inflammation and Recovery of Muscle Function
after Damaging Exercise: Effect of 6-Week Mixed Antioxidant Supplementation. Eur. J. Appl. Physiol. 2011, 111, 925–936.
[CrossRef]
111. Mastaloudis, A.; Morrow, J.D.; Hopkins, D.W.; Devaraj, S.; Traber, M.G. Antioxidant Supplementation Prevents Exercise-Induced
Lipid Peroxidation, but Not Inflammation, in Ultramarathon Runners. Free Radic. Biol. Med. 2004, 36, 1329–1341. [CrossRef]
112. Teixeira, V.H.; Valente, H.F.; Casal, S.I.; Marques, A.F.; Moreira, P.A. Antioxidants Do Not Prevent Postexercise Peroxidation and
May Delay Muscle Recovery. Med. Sci. Sports Exerc. 2009, 41, 1752–1760. [CrossRef]
Nutrients 2023, 15, 2371 31 of 35

113. Cani, P.D.; Van Hul, M.; Lefort, C.; Depommier, C.; Rastelli, M.; Everard, A. Microbial Regulation of Organismal Energy
Homeostasis. Nat. Metab. 2019, 1, 34–46. [CrossRef]
114. Cataldi, S.; Bonavolontà, V.; Poli, L.; Clemente, F.M.; De Candia, M.; Carvutto, R.; Silva, A.F.; Badicu, G.; Greco, G.; Fischetti, F.
The Relationship between Physical Activity, Physical Exercise, and Human Gut Microbiota in Healthy and Unhealthy Subjects: A
Systematic Review. Biology 2022, 11, 479. [CrossRef]
115. Gazerani, P. Migraine and Diet. Nutrients 2020, 12, 1658. [CrossRef]
116. Cerdá, B.; Pérez, M.; Pérez-Santiago, J.D.; Tornero-Aguilera, J.F.; González-Soltero, R.; Larrosa, M. Gut Microbiota Modification:
Another Piece in the Puzzle of the Benefits of Physical Exercise in Health? Front. Physiol. 2016, 7, 51. [CrossRef]
117. Kanter, M.M. Nutritional Antioxidants and Physical Activity. In Nutrition in Exercise and Sport, 3rd ed.; CRC Press: Boca Raton,
FL, USA, 1997.
118. Arias Calvo, A.; Feijoo Costa, G.; Moreira Vilar, M.T. Exploring the Potential of Antioxidants from Fruits and Vegetables and
Strategies for Their Recovery. Innov. Food Sci. Emerg. Technol. 2022, 77, 102974. [CrossRef]
119. Álvarez, J.; Fernández Real, J.M.; Guarner, F.; Gueimonde, M.; Rodríguez, J.M.; Saenz de Pipaon, M.; Sanz, Y. Gut Microbes and
Health. Gastroenterol. Hepatol. 2021, 44, 519–535. [CrossRef]
120. Fiedor, J.; Burda, K. Potential Role of Carotenoids as Antioxidants in Human Health and Disease. Nutrients 2014, 6, 466–488.
[CrossRef]
121. Rao, A.V.; Rao, L.G. Carotenoids and Human Health. Pharm. Res. 2007, 55, 207–216. [CrossRef]
122. Bin-Jumah, M.N.; Nadeem, M.S.; Gilani, S.J.; Mubeen, B.; Ullah, I.; Alzarea, S.I.; Ghoneim, M.M.; Alshehri, S.; Al-Abbasi, F.A.;
Kazmi, I. Lycopene: A Natural Arsenal in the War against Oxidative Stress and Cardiovascular Diseases. Antioxidants 2022, 11,
232. [CrossRef]
123. Ekpe, L.; Inaku, K.; Ekpe, V. Antioxidant Effects of Astaxanthin in Various Diseasesa Review. J. Mol. Pathophysiol. 2018, 7, 1.
[CrossRef]
124. Wu, L.; Lu, P.; Guo, X.; Song, K.; Lyu, Y.; Bothwell, J.; Wu, J.; Hawkins, O.; Clarke, S.L.; Lucas, E.A.; et al. β-Carotene Oxygenase 2
Deficiency-Triggered Mitochondrial Oxidative Stress Promotes Low-Grade Inflammation and Metabolic Dysfunction. Free Radic.
Biol. Med. 2021, 164, 271–284. [CrossRef]
125. Honarbakhsh, M.; Malta, K.; Ericsson, A.; Holloway, C.; Kim, Y.-K.; Hammerling, U.; Quadro, L. β-Carotene Improves Fecal
Dysbiosis and Intestinal Dysfunctions in a Mouse Model of Vitamin A Deficiency. Biochim. Biophys. Acta Mol. Cell. Biol. Lipids
2022, 1867, 159122. [CrossRef]
126. Deis, L.; Quiroga, A.M.; De Rosas, M.I. Coloured Compounds in Fruits and Vegetables and Health. In Psychiatry and Neuroscience
Update: From Epistemology to Clinical Psychiatry—Vol. IV.; Gargiulo, P.Á., Mesones Arroyo, H.L., Eds.; Springer International
Publishing: Cham, Switzerland, 2021; pp. 343–358. ISBN 978-3-030-61721-9.
127. Hollman, P.C.H.; Cassidy, A.; Comte, B.; Heinonen, M.; Richelle, M.; Richling, E.; Serafini, M.; Scalbert, A.; Sies, H.; Vidry, S. The
Biological Relevance of Direct Antioxidant Effects of Polyphenols for Cardiovascular Health in Humans Is Not Established. J.
Nutr. 2011, 141, 989S–1009S. [CrossRef] [PubMed]
128. Pallauf, K.; Giller, K.; Huebbe, P.; Rimbach, G. Nutrition and Healthy Ageing: Calorie Restriction or Polyphenol-Rich “Mediter-
rAsian” Diet? Oxidative Med. Cell. Longev. 2013, 2013, e707421. [CrossRef] [PubMed]
129. Barreca, D.; Trombetta, D.; Smeriglio, A.; Mandalari, G.; Romeo, O.; Felice, M.R.; Gattuso, G.; Nabavi, S. Food Flavonols:
Nutraceuticals with Complex Health Benefits and Functionalities. Trends Food Sci. Technol. 2021, 117, 194–204. [CrossRef]
130. Flavonoids: Biosynthesis, Metabolism, Mechanism of Antioxidation and Clinical Implications: A Review. Available online:
https://arccjournals.com/journal/agricultural-reviews/R-1922 (accessed on 3 April 2023).
131. Mattioli, R.; Francioso, A.; Mosca, L.; Silva, P. Anthocyanins: A Comprehensive Review of Their Chemical Properties and Health
Effects on Cardiovascular and Neurodegenerative Diseases. Molecules 2020, 25, 3809. [CrossRef]
132. Gomes, J.V.P.; Rigolon, T.C.B.; da Silveira Souza, M.S.; Alvarez-Leite, J.I.; Della Lucia, C.M.; Martino, H.S.D.; Rosa, C.D.O.B.
Antiobesity Effects of Anthocyanins on Mitochondrial Biogenesis, Inflammation, and Oxidative Stress: A Systematic Review.
Nutrition 2019, 66, 192–202. [CrossRef]
133. Chan, S.W.; Chu, T.T.W.; Choi, S.W.; Benzie, I.F.F.; Tomlinson, B. Impact of Short-Term Bilberry Supplementation on Glycemic
Control, Cardiovascular Disease Risk Factors, and Antioxidant Status in Chinese Patients with Type 2 Diabetes. Phytother. Res.
2021, 35, 3236–3245. [CrossRef]
134. Man, A.W.C.; Zhou, Y.; Xia, N.; Li, H. Involvement of Gut Microbiota, Microbial Metabolites and Interaction with Polyphenol in
Host Immunometabolism. Nutrients 2020, 12, 3054. [CrossRef]
135. Otten, A.T.; Bourgonje, A.R.; Peters, V.; Alizadeh, B.Z.; Dijkstra, G.; Harmsen, H.J.M. Vitamin C Supplementation in Healthy
Individuals Leads to Shifts of Bacterial Populations in the Gut-A Pilot Study. Antioxidants 2021, 10, 1278. [CrossRef]
136. Pawlowska, E.; Szczepanska, J.; Blasiak, J. Pro- and Antioxidant Effects of Vitamin C in Cancer in Correspondence to Its Dietary
and Pharmacological Concentrations. Oxid. Med. Cell. Longev. 2019, 2019, 7286737. [CrossRef]
137. Blaner, W.S.; Shmarakov, I.O.; Traber, M.G. Vitamin A and Vitamin E: Will the Real Antioxidant Please Stand Up? Annu. Rev.
Nutr. 2021, 41, 105–131. [CrossRef]
138. Orsavová, J.; Hlaváčová, I.; Mlček, J.; Snopek, L.; Mišurcová, L. Contribution of Phenolic Compounds, Ascorbic Acid and Vitamin
E to Antioxidant Activity of Currant (Ribes L.) and Gooseberry (Ribes Uva-Crispa L.) Fruits. Food Chem. 2019, 284, 323–333.
[CrossRef]
Nutrients 2023, 15, 2371 32 of 35

139. Choi, Y.; Lee, S.; Kim, S.; Lee, J.; Ha, J.; Oh, H.; Lee, Y.; Kim, Y.; Yoon, Y. Vitamin E (α-Tocopherol) Consumption Influences Gut
Microbiota Composition. Int. J. Food Sci. Nutr. 2020, 71, 221–225. [CrossRef]
140. Prasad, A.S.; Bao, B. Molecular Mechanisms of Zinc as a Pro-Antioxidant Mediator: Clinical Therapeutic Implications. Antioxidants
2019, 8, 164. [CrossRef]
141. Barma, M.D.; Muthupandiyan, I.; Samuel, S.R.; Amaechi, B.T. Inhibition of Streptococcus Mutans, Antioxidant Property and
Cytotoxicity of Novel Nano-Zinc Oxide Varnish. Arch. Oral. Biol. 2021, 126, 105132. [CrossRef]
142. Chinni, V.; El-Khoury, J.; Perera, M.; Bellomo, R.; Jones, D.; Bolton, D.; Ischia, J.; Patel, O. Zinc Supplementation as an Adjunct
Therapy for COVID-19: Challenges and Opportunities. Br. J. Clin. Pharm. 2021, 87, 3737–3746. [CrossRef]
143. Full Article: Use of Biological Nano Zinc as a Feed Additive in Quail Nutrition: Biosynthesis, Antimicrobial Activity and Its
Effect on Growth, Feed Utilisation, Blood Metabolites and Intestinal Microbiota. Available online: https://www.tandfonline.
com/doi/full/10.1080/1828051X.2021.1886001 (accessed on 3 April 2023).
144. Skalny, A.V.; Aschner, M.; Lei, X.G.; Gritsenko, V.A.; Santamaria, A.; Alekseenko, S.I.; Prakash, N.T.; Chang, J.-S.; Sizova, E.A.;
Chao, J.C.J.; et al. Gut Microbiota as a Mediator of Essential and Toxic Effects of Zinc in the Intestines and Other Tissues. Int. J.
Mol. Sci. 2021, 22, 13074. [CrossRef]
145. Bjørklund, G.; Shanaida, M.; Lysiuk, R.; Antonyak, H.; Klishch, I.; Shanaida, V.; Peana, M. Selenium: An Antioxidant with a
Critical Role in Anti-Aging. Molecules 2022, 27, 6613. [CrossRef]
146. Huang, J.; Zheng, C.; Luo, R.; Cao, X.; Liu, M.; Gu, Q.; Li, F.; Li, J.; Wu, X.; Yang, Z.; et al. Integrative Analysis of Multiomics Data
Identifies Selenium-Related Gene ALAD Associating with Keshan Disease. Free Radic. Biol. Med. 2022, 193, 702–719. [CrossRef]
147. Zhu, K.; Yang, S.; Li, T.; Huang, X.; Dong, Y.; Wang, P.; Huang, J. Advances in the Study of the Mechanism by Which Selenium
and Selenoproteins Boost Immunity to Prevent Food Allergies. Nutrients 2022, 14, 3133. [CrossRef]
148. Ferreira, R.L.U.; Sena-Evangelista, K.C.M.; de Azevedo, E.P.; Pinheiro, F.I.; Cobucci, R.N.; Pedrosa, L.F.C. Selenium in Human
Health and Gut Microflora: Bioavailability of Selenocompounds and Relationship with Diseases. Front. Nutr. 2021, 8, 685317.
[CrossRef]
149. Mushtaq, M.; Fatima, M.; Hussain Shah, S.Z.; Khan, N.; Naveed, S.; Khan, M. Effects of Sodium Selenite, Selenium Methionine,
and Selenium Yeast on Growth Performance, Carcass Composition, Blood Biochemistry, and Antioxidant Status of Intensively
Reared Hypophthalmichthys Molitrix. Aquac. Rep. 2022, 24, 101182. [CrossRef]
150. Yu, M.; Yue, J.; Hui, N.; Zhi, Y.; Hayat, K.; Yang, X.; Zhang, D.; Chu, S.; Zhou, P. Anti-Hyperlipidemia and Gut Microbiota
Community Regulation Effects of Selenium-Rich Cordyceps Militaris Polysaccharides on the High-Fat Diet-Fed Mice Model.
Foods 2021, 10, 2252. [CrossRef] [PubMed]
151. Naliyadhara, N.; Kumar, A.; Kumar Gangwar, S.; Nair Devanarayanan, T.; Hegde, M.; Alqahtani, M.S.; Abbas, M.; Sethi, G.;
Kunnumakkara, A. Interplay of Dietary Antioxidants and Gut Microbiome in Human Health: What Has Been Learnt Thus Far? J.
Funct. Foods 2023, 100, 105365. [CrossRef]
152. Li, Z.; Dong, Y.; Chen, S.; Jia, X.; Jiang, X.; Che, L.; Lin, Y.; Li, J.; Feng, B.; Fang, Z.; et al. Organic Selenium Increased Gilts
Antioxidant Capacity, Immune Function, and Changed Intestinal Microbiota. Front. Microbiol. 2021, 12, 723190. [CrossRef]
153. Effect of Different Dietary Selenium Sources on Growth Performance, Antioxidant Capacity, Gut Microbiota, and Molecular
Responses in Pacific White Shrimp Litopenaeus Vannamei. Available online: https://www.hindawi.com/journals/anu/2022/5
738008/ (accessed on 3 April 2023).
154. Reid, M.B. Redox Interventions to Increase Exercise Performance. J. Physiol. 2016, 594, 5125–5133. [CrossRef]
155. Slattery, K.; Bentley, D.; Coutts, A.J. The Role of Oxidative, Inflammatory and Neuroendocrinological Systems during Exercise
Stress in Athletes: Implications of Antioxidant Supplementation on Physiological Adaptation during Intensified Physical Training.
Sports Med. 2015, 45, 453–471. [CrossRef]
156. Margaritelis, N.V.; Cobley, J.N.; Paschalis, V.; Veskoukis, A.S.; Theodorou, A.A.; Kyparos, A.; Nikolaidis, M.G. Principles for
Integrating Reactive Species into in Vivo Biological Processes: Examples from Exercise Physiology. Cell. Signal. 2016, 28, 256–271.
[CrossRef]
157. Tsai, K.; Hsu, T.G.; Hsu, K.M.; Cheng, H.; Liu, T.Y.; Hsu, C.F.; Kong, C.W. Oxidative DNA Damage in Human Peripheral
Leukocytes Induced by Massive Aerobic Exercise. Free Radic. Biol. Med. 2001, 31, 1465–1472. [CrossRef]
158. Torre, M.F.; Martinez-Ferran, M.; Vallecillo, N.; Jiménez, S.L.; Romero-Morales, C.; Pareja-Galeano, H. Supplementation with
Vitamins C and E and Exercise-Induced Delayed-Onset Muscle Soreness: A Systematic Review. Antioxidants 2021, 10, 279.
[CrossRef]
159. Canals-Garzón, C.; Guisado-Barrilao, R.; Martínez-García, D.; Chirosa-Ríos, I.J.; Jerez-Mayorga, D.; Guisado-Requena, I.M. Effect
of Antioxidant Supplementation on Markers of Oxidative Stress and Muscle Damage after Strength Exercise: A Systematic
Review. Int. J. Env. Res. Public. Health 2022, 19, 1803. [CrossRef]
160. Costello, J.T.; Baker, P.R.A.; Minett, G.M.; Bieuzen, F.; Stewart, I.B.; Bleakley, C. Whole-Body Cryotherapy (Extreme Cold Air
Exposure) for Preventing and Treating Muscle Soreness after Exercise in Adults. Cochrane Database Syst. Rev. 2015, 2015, CD010789.
[CrossRef]
161. Ranchordas, M.K.; Rogerson, D.; Soltani, H.; Costello, J.T. Antioxidants for Preventing and Reducing Muscle Soreness after
Exercise: A Cochrane Systematic Review. Br. J. Sports Med. 2020, 54, 74–78. [CrossRef]
162. Howatson, G.; McHugh, M.P.; Hill, J.A.; Brouner, J.; Jewell, A.P.; van Someren, K.A.; Shave, R.E.; Howatson, S.A. Influence of Tart
Cherry Juice on Indices of Recovery Following Marathon Running. Scand. J. Med. Sci. Sports 2010, 20, 843–852. [CrossRef]
Nutrients 2023, 15, 2371 33 of 35

163. Leonardo-Mendonça, R.C.; Ocaña-Wilhelmi, J.; de Haro, T.; de Teresa-Galván, C.; Guerra-Hernández, E.; Rusanova, I.; Fernández-
Ortiz, M.; Sayed, R.K.A.; Escames, G.; Acuña-Castroviejo, D. The Benefit of a Supplement with the Antioxidant Melatonin on
Redox Status and Muscle Damage in Resistance-Trained Athletes. Appl. Physiol. Nutr. Metab. 2017, 42, 700–707. [CrossRef]
164. Ortiz-Franco, M.; Planells, E.; Quintero, B.; Acuña-Castroviejo, D.; Rusanova, I.; Escames, G.; Molina-López, J. Effect of Melatonin
Supplementation on Antioxidant Status and DNA Damage in High Intensity Trained Athletes. Int. J. Sports Med. 2017, 38,
1117–1125. [CrossRef]
165. Stefan, M.; Sharp, M.; Gheith, R.; Lowery, R.; Ottinger, C.; Wilson, J.; Durkee, S.; Bellamine, A. L-Carnitine Tartrate Supplemen-
tation for 5 Weeks Improves Exercise Recovery in Men and Women: A Randomized, Double-Blind, Placebo-Controlled Trial.
Nutrients 2021, 13, 3432. [CrossRef]
166. Silva, L.A.; Pinho, C.A.; Silveira, P.C.L.; Tuon, T.; De Souza, C.T.; Dal-Pizzol, F.; Pinho, R.A. Vitamin E Supplementation Decreases
Muscular and Oxidative Damage but Not Inflammatory Response Induced by Eccentric Contraction. J. Physiol. Sci. 2010, 60,
51–57. [CrossRef]
167. De Oliveira, D.C.X.; Rosa, F.T.; Simões-Ambrósio, L.; Jordao, A.A.; Deminice, R. Antioxidant Vitamin Supplementation Prevents
Oxidative Stress but Does Not Enhance Performance in Young Football Athletes. Nutrition 2019, 63–64, 29–35. [CrossRef]
168. Zhang, T.; Zhao, T.; Zhang, Y.; Liu, T.; Gagnon, G.; Ebrahim, J.; Johnson, J.; Chu, Y.-F.; Ji, L.L. Avenanthramide Supplementation
Reduces Eccentric Exercise-Induced Inflammation in Young Men and Women. J. Int. Soc. Sports Nutr. 2020, 17, 41. [CrossRef]
169. Drobnic, F.; Riera, J.; Appendino, G.; Togni, S.; Franceschi, F.; Valle, X.; Pons, A.; Tur, J. Reduction of Delayed Onset Muscle
Soreness by a Novel Curcumin Delivery System (Meriva®): A Randomised, Placebo-Controlled Trial. J. Int. Soc. Sports Nutr. 2014,
11, 31. [CrossRef]
170. He, F.; Hockemeyer, J.A.K.; Sedlock, D. Does Combined Antioxidant Vitamin Supplementation Blunt Repeated Bout Effect? Int. J.
Sports Med. 2015, 36, 407–413. [CrossRef] [PubMed]
171. Close, G.L.; Ashton, T.; Cable, T.; Doran, D.; Holloway, C.; McArdle, F.; MacLaren, D.P.M. Ascorbic Acid Supplementation Does
Not Attenuate Post-Exercise Muscle Soreness Following Muscle-Damaging Exercise but May Delay the Recovery Process. Br. J.
Nutr. 2006, 95, 976–981. [CrossRef] [PubMed]
172. Kashef, M. Effect of Vitamin E Supplementation on Delayed Onset Muscle Soreness in Young Men. J. Phys. Act. Horm. 2018, 2,
15–28.
173. McGinley, C.; Shafat, A.; Donnelly, A.E. Does Antioxidant Vitamin Supplementation Protect against Muscle Damage? Sports Med.
2009, 39, 1011–1032. [CrossRef]
174. Peternelj, T.-T.; Coombes, J.S. Antioxidant Supplementation during Exercise Training: Beneficial or Detrimental? Sports Med. 2011,
41, 1043–1069. [CrossRef]
175. Fitó, M.; Guxens, M.; Corella, D.; Sáez, G.; Estruch, R.; de la Torre, R.; Francés, F.; Cabezas, C.; López-Sabater, M.D.C.; Marrugat,
J.; et al. Effect of a Traditional Mediterranean Diet on Lipoprotein Oxidation: A Randomized Controlled Trial. Arch. Intern. Med.
2007, 167, 1195–1203. [CrossRef]
176. Braakhuis, A.J.; Hopkins, W.G.; Lowe, T.E. Effects of Dietary Antioxidants on Training and Performance in Female Runners. Eur.
J. Sport Sci. 2014, 14, 160–168. [CrossRef]
177. Aguiló, A.; Tauler, P.; Sureda, A.; Cases, N.; Tur, J.; Pons, A. Antioxidant Diet Supplementation Enhances Aerobic Performance in
Amateur Sportsmen. J. Sports Sci. 2007, 25, 1203–1210. [CrossRef]
178. Paulsen, G.; Cumming, K.T.; Holden, G.; Hallén, J.; Rønnestad, B.R.; Sveen, O.; Skaug, A.; Paur, I.; Bastani, N.E.; Østgaard, H.N.;
et al. Vitamin C and E Supplementation Hampers Cellular Adaptation to Endurance Training in Humans: A Double-Blind,
Randomised, Controlled Trial. J. Physiol. 2014, 592, 1887–1901. [CrossRef]
179. Daneshvar, P.; Hariri, M.; Ghiasvand, R.; Askari, G.; Darvishi, L.; Mashhadi, N.S.; Khosravi-Boroujeni, H. Effect of Eight Weeks of
Quercetin Supplementation on Exercise Performance, Muscle Damage and Body Muscle in Male Badminton Players. Int. J. Prev.
Med. 2013, 4, S53–S57.
180. MacRae, H.S.H.; Mefferd, K.M. Dietary Antioxidant Supplementation Combined with Quercetin Improves Cycling Time Trial
Performance. Int. J. Sport Nutr. Exerc. Metab. 2006, 16, 405–419. [CrossRef]
181. Darvishi, L.; Ghiasvand, R.; Hariri, M.; Askari, G.; Rezai, P.; Aghaie, M.; Iraj, B.; Khosravi-Boroujeni, H.; Mashhadi, N.S. Quercetin
Supplementation Does Not Attenuate Exercise Performance and Body Composition in Young Female Swimmers. Int. J. Prev. Med.
2013, 4, S43–S47.
182. Ganio, M.S.; Armstrong, L.E.; Johnson, E.C.; Klau, J.F.; Ballard, K.D.; Michniak-Kohn, B.; Kaushik, D.; Maresh, C.M. Effect of
Quercetin Supplementation on Maximal Oxygen Uptake in Men and Women. J. Sports Sci. 2010, 28, 201–208. [CrossRef]
183. Gliemann, L.; Schmidt, J.F.; Olesen, J.; Biensø, R.S.; Peronard, S.L.; Grandjean, S.U.; Mortensen, S.P.; Nyberg, M.; Bangsbo, J.;
Pilegaard, H.; et al. Resveratrol Blunts the Positive Effects of Exercise Training on Cardiovascular Health in Aged Men. J. Physiol.
2013, 591, 5047–5059. [CrossRef]
184. Wylie, L.J.; Kelly, J.; Bailey, S.J.; Blackwell, J.R.; Skiba, P.F.; Winyard, P.G.; Jeukendrup, A.E.; Vanhatalo, A.; Jones, A.M. Beetroot
Juice and Exercise: Pharmacodynamic and Dose-Response Relationships. J. Appl. Physiol. 2013, 115, 325–336. [CrossRef]
185. Lansley, K.E.; Winyard, P.G.; Bailey, S.J.; Vanhatalo, A.; Wilkerson, D.P.; Blackwell, J.R.; Gilchrist, M.; Benjamin, N.; Jones, A.M.
Acute Dietary Nitrate Supplementation Improves Cycling Time Trial Performance. Med. Sci. Sports Exerc. 2011, 43, 1125–1131.
[CrossRef]
Nutrients 2023, 15, 2371 34 of 35

186. Wylie, L.J.; Mohr, M.; Krustrup, P.; Jackman, S.R.; Ermιdis, G.; Kelly, J.; Black, M.I.; Bailey, S.J.; Vanhatalo, A.; Jones, A.M. Dietary
Nitrate Supplementation Improves Team Sport-Specific Intense Intermittent Exercise Performance. Eur. J. Appl. Physiol. 2013, 113,
1673–1684. [CrossRef]
187. Hoon, M.W.; Johnson, N.A.; Chapman, P.G.; Burke, L.M. The Effect of Nitrate Supplementation on Exercise Performance in
Healthy Individuals: A Systematic Review and Meta-Analysis. Int. J. Sport Nutr. Exerc. Metab. 2013, 23, 522–532. [CrossRef]
188. Simioni, C.; Zauli, G.; Martelli, A.M.; Vitale, M.; Sacchetti, G.; Gonelli, A.; Neri, L.M. Oxidative Stress: Role of Physical Exercise
and Antioxidant Nutraceuticals in Adulthood and Aging. Oncotarget 2018, 9, 17181–17198. [CrossRef]
189. Shafat, A.; Butler, P.; Jensen, R.L.; Donnelly, A.E. Effects of Dietary Supplementation with Vitamins C and E on Muscle Function
during and after Eccentric Contractions in Humans. Eur. J. Appl. Physiol. 2004, 93, 196–202. [CrossRef]
190. Xie, D.; Hu, J.; Yang, Z.; Wu, T.; Xu, W.; Meng, Q.; Cao, K.; Luo, X. Vitamin Supplementation Protects against Nanomaterial-
Induced Oxidative Stress and Inflammation Damages: A Meta-Analysis of In Vitro and In Vivo Studies. Nutrients 2022, 14, 2214.
[CrossRef] [PubMed]
191. Santos, S.A.; Silva, E.T.; Caris, A.V.; Lira, F.S.; Tufik, S.; Dos Santos, R.V.T. Vitamin E Supplementation Inhibits Muscle Damage
and Inflammation after Moderate Exercise in Hypoxia. J. Hum. Nutr. Diet. 2016, 29, 516–522. [CrossRef] [PubMed]
192. Sacheck, J.M.; Decker, E.A.; Clarkson, P.M. The Effect of Diet on Vitamin E Intake and Oxidative Stress in Response to Acute
Exercise in Female Athletes. Eur. J. Appl. Physiol. 2000, 83, 40–46. [CrossRef] [PubMed]
193. Takanami, Y.; Iwane, H.; Kawai, Y.; Shimomitsu, T. Vitamin E Supplementation and Endurance Exercise. Sports Med. 2000, 29,
73–83. [CrossRef] [PubMed]
194. Capozzi, A.; Saucier, C.; Bisbal, C.; Lambert, K. Grape Polyphenols in the Treatment of Human Skeletal Muscle Damage Due to
Inflammation and Oxidative Stress during Obesity and Aging: Early Outcomes and Promises. Molecules 2022, 27, 6594. [CrossRef]
195. Pugh, J.; Close, G. Nutritional Antioxidants for Sports Performance. In Oxidative Eustress in Exercise Physiology; CRC Press: Boca
Raton, FL, USA, 2022; pp. 115–122. ISBN 978-1-00-305161-9.
196. Kan, N.-W.; Ho, C.-S.; Chiu, Y.-S.; Huang, W.-C.; Chen, P.-Y.; Tung, Y.-T.; Huang, C.-C. Effects of Resveratrol Supplementation and
Exercise Training on Exercise Performance in Middle-Aged Mice. Molecules 2016, 21, 661. [CrossRef]
197. Huang, C.-C.; Liu, C.-C.; Tsao, J.-P.; Hsu, C.-L.; Cheng, I.-S. Effects of Oral Resveratrol Supplementation on Glycogen Replenish-
ment and Mitochondria Biogenesis in Exercised Human Skeletal Muscle. Nutrients 2020, 12, 3721. [CrossRef]
198. Scribbans, T.D.; Ma, J.K.; Edgett, B.A.; Vorobej, K.A.; Mitchell, A.S.; Zelt, J.G.E.; Simpson, C.A.; Quadrilatero, J.; Gurd, B.J.
Resveratrol Supplementation Does Not Augment Performance Adaptations or Fibre-Type-Specific Responses to High-Intensity
Interval Training in Humans. Appl. Physiol. Nutr. Metab. 2014, 39, 1305–1313. [CrossRef]
199. Marx, W.; Kelly, J.; Marshall, S.; Cutajar, J.; Annois, B.; Pipingas, A.; Tierney, A.; Itsiopoulos, C. Effect of Resveratrol Supple-
mentation on Cognitive Performance and Mood in Adults: A Systematic Literature Review and Meta-Analysis of Randomized
Controlled Trials. Nutr. Rev. 2018, 76, 432–443. [CrossRef]
200. Ostman, B.; Sjödin, A.; Michaëlsson, K.; Byberg, L. Coenzyme Q10 Supplementation and Exercise-Induced Oxidative Stress in
Humans. Nutrition 2012, 28, 403–417. [CrossRef]
201. Cooke, M.; Iosia, M.; Buford, T.; Shelmadine, B.; Hudson, G.; Kerksick, C.; Rasmussen, C.; Greenwood, M.; Leutholtz, B.;
Willoughby, D.; et al. Effects of Acute and 14-Day Coenzyme Q10 Supplementation on Exercise Performance in Both Trained and
Untrained Individuals. J. Int. Soc. Sports Nutr. 2008, 5, 8. [CrossRef]
202. Leelarungrayub, D.; Sawattikanon, N.; Klaphajone, J.; Pothongsunan, P.; Bloomer, R.J. Coenzyme Q10 Supplementation Decreases
Oxidative Stress and Improves Physical Performance in Young Swimmers: A Pilot Study. Open Sports Med. J. 2010, 4, 1–8.
[CrossRef]
203. Emami, A.; Tofighi, A.; Asri-Rezaei, S.; Bazargani-Gilani, B. The Effect of Short-Term Coenzyme Q10 Supplementation and
Pre-Cooling Strategy on Cardiac Damage Markers in Elite Swimmers. Br. J. Nutr. 2018, 119, 381–390. [CrossRef]
204. Astani, K.; Bashiri, J.; Pourrazi, H.; Nourazar, M.A. Effect of High-Intensity Interval Training and Coenzyme Q10 Supplementation
on Cardiac Apoptosis in Obese Male Rats. ARYA Atheroscler. 2022, 18, 1–9. [CrossRef]
205. Ghiasi, S.; Bashiri, J.; Pourrazi, H.; Jadidi, R. The Effect of High-Intensity Interval Training and CoQ10 Administration on Hepatic
CEACAM1 and PDGFA Proteins in Diet-Induced Obese Rats. Sport Sci. Health 2022, 1–8. [CrossRef]
206. Fernández-Lázaro, D.; Fernandez-Lazaro, C.I.; Mielgo-Ayuso, J.; Navascués, L.J.; Córdova Martínez, A.; Seco-Calvo, J. The Role
of Selenium Mineral Trace Element in Exercise: Antioxidant Defense System, Muscle Performance, Hormone Response, and
Athletic Performance. A Systematic Review. Nutrients 2020, 12, 1790. [CrossRef]
207. Rayman, M.P.; Stranges, S.; Griffin, B.A.; Pastor-Barriuso, R.; Guallar, E. Effect of Supplementation with High-Selenium Yeast on
Plasma Lipids: A Randomized Trial. Ann. Intern. Med. 2011, 154, 656–665. [CrossRef]
208. Fernández-Lázaro, D.; Mielgo-Ayuso, J.; Seco Calvo, J.; Córdova Martínez, A.; Caballero García, A.; Fernandez-Lazaro, C.I.
Modulation of Exercise-Induced Muscle Damage, Inflammation, and Oxidative Markers by Curcumin Supplementation in a
Physically Active Population: A Systematic Review. Nutrients 2020, 12, 501. [CrossRef]
209. Nicol, L.M.; Rowlands, D.S.; Fazakerly, R.; Kellett, J. Curcumin Supplementation Likely Attenuates Delayed Onset Muscle
Soreness (DOMS). Eur. J. Appl. Physiol. 2015, 115, 1769–1777. [CrossRef]
210. Tanabe, Y.; Maeda, S.; Akazawa, N.; Zempo-Miyaki, A.; Choi, Y.; Ra, S.-G.; Imaizumi, A.; Otsuka, Y.; Nosaka, K. Attenuation
of Indirect Markers of Eccentric Exercise-Induced Muscle Damage by Curcumin. Eur. J. Appl. Physiol. 2015, 115, 1949–1957.
[CrossRef]
Nutrients 2023, 15, 2371 35 of 35

211. Criswell, D.; Powers, S.; Dodd, S.; Lawler, J.; Edwards, W.; Renshler, K.; Grinton, S. High Intensity Training-Induced Changes in
Skeletal Muscle Antioxidant Enzyme Activity. Med. Sci. Sports Exerc. 1993, 25, 1135–1140. [CrossRef]
212. Beaton, L.J.; Allan, D.A.; Tarnopolsky, M.A.; Tiidus, P.M.; Phillips, S.M. Contraction-Induced Muscle Damage Is Unaffected by
Vitamin E Supplementation. Med. Sci. Sports Exerc. 2002, 34, 798–805. [CrossRef] [PubMed]
213. Tsao, J.-P.; Liu, C.-C.; Wang, H.-F.; Bernard, J.R.; Huang, C.-C.; Cheng, I.-S. Oral Resveratrol Supplementation Attenuates
Exercise-Induced Interleukin-6 but Not Oxidative Stress after a High Intensity Cycling Challenge in Adults. Int. J. Med. Sci. 2021,
18, 2137–2145. [CrossRef] [PubMed]
214. Novelle, M.G.; Wahl, D.; Diéguez, C.; Bernier, M.; de Cabo, R. Resveratrol Supplementation: Where Are We Now and Where
Should We Go? Ageing Res. Rev. 2015, 21, 1–15. [CrossRef] [PubMed]
215. Drobnic, F.; Lizarraga, M.A.; Caballero-García, A.; Cordova, A. Coenzyme Q10 Supplementation and Its Impact on Exercise and
Sport Performance in Humans: A Recovery or a Performance-Enhancing Molecule? Nutrients 2022, 14, 1811. [CrossRef]
216. Kon, M.; Tanabe, K.; Akimoto, T.; Kimura, F.; Tanimura, Y.; Shimizu, K.; Okamoto, T.; Kono, I. Reducing Exercise-Induced
Muscular Injury in Kendo Athletes with Supplementation of Coenzyme Q10. Br. J. Nutr. 2008, 100, 903–909. [CrossRef]
217. Wrobel, J.K.; Power, R.; Toborek, M. Biological Activity of Selenium: Revisited. IUBMB Life 2016, 68, 97–105. [CrossRef]
218. Bai, K.-Y.; Liu, G.-H.; Fan, C.-H.; Kuo, L.-T.; Hsu, W.-H.; Yu, P.-A.; Chen, C.-L. 12-Week Curcumin Supplementation May Relieve
Postexercise Muscle Fatigue in Adolescent Athletes. Front. Nutr. 2022, 9, 1078108. [CrossRef]
219. Salehi, M.; Mashhadi, N.S.; Esfahani, P.S.; Feizi, A.; Hadi, A.; Askari, G. The Effects of Curcumin Supplementation on Muscle
Damage, Oxidative Stress, and Inflammatory Markers in Healthy Females with Moderate Physical Activity: A Randomized,
Double-Blind, Placebo-Controlled Clinical Trial. Int. J. Prev. Med. 2021, 12, 94. [CrossRef]
220. Gammone, M.A.; Riccioni, G.; Parrinello, G.; D’Orazio, N. Omega-3 Polyunsaturated Fatty Acids: Benefits and Endpoints in
Sport. Nutrients 2018, 11, 46. [CrossRef]
221. McGlory, C.; Wardle, S.L.; Macnaughton, L.S.; Witard, O.C.; Scott, F.; Dick, J.; Bell, J.G.; Phillips, S.M.; Galloway, S.D.R.; Hamilton,
D.L.; et al. Fish Oil Supplementation Suppresses Resistance Exercise and Feeding-Induced Increases in Anabolic Signaling
without Affecting Myofibrillar Protein Synthesis in Young Men. Physiol. Rep. 2016, 4, e12715. [CrossRef]
222. Kara, E.; Gunay, M.; Cicioglu, I.; Ozal, M.; Kilic, M.; Mogulkoc, R.; Baltaci, A.K. Effect of Zinc Supplementation on Antioxidant
Activity in Young Wrestlers. Biol. Trace Elem. Res. 2010, 134, 55–63. [CrossRef]
223. Lukaski, H.C. Vitamin and Mineral Status: Effects on Physical Performance. Nutrition 2004, 20, 632–644. [CrossRef]
224. Cinar, V.; Akbulut, T.; Kilic, Y.; Özdal, M.; Sarikaya, M. The Effect of 6-Week Zinc Supplement and Weight Training on the Blood
Lipids of the Sedentaries and Athletes. Cell. Mol. Biol. 2018, 64, 1–5. [CrossRef]
225. Schmitt, B.; Vicenzi, M.; Garrel, C.; Denis, F.M. Effects of N-Acetylcysteine, Oral Glutathione (GSH) and a Novel Sublingual Form
of GSH on Oxidative Stress Markers: A Comparative Crossover Study. Redox Biol. 2015, 6, 198–205. [CrossRef]
226. Saitoh, T.; Satoh, H.; Nobuhara, M.; Machii, M.; Tanaka, T.; Ohtani, H.; Saotome, M.; Urushida, T.; Katoh, H.; Hayashi, H. Intra-
venous Glutathione Prevents Renal Oxidative Stress after Coronary Angiography More Effectively than Oral N-Acetylcysteine.
Heart Vessel. 2011, 26, 465–472. [CrossRef]
227. Søndergård, S.D.; Cintin, I.; Kuhlman, A.B.; Morville, T.H.; Bergmann, M.L.; Kjær, L.K.; Poulsen, H.E.; Giustarini, D.; Rossi, R.;
Dela, F.; et al. The Effects of 3 Weeks of Oral Glutathione Supplementation on Whole Body Insulin Sensitivity in Obese Males
with and without Type 2 Diabetes: A Randomized Trial. Appl. Physiol. Nutr. Metab. 2021, 46, 1133–1142. [CrossRef]
228. Rhodes, K.; Braakhuis, A. Performance and Side Effects of Supplementation with N-Acetylcysteine: A Systematic Review and
Meta-Analysis. Sports Med. 2017, 47, 1619–1636. [CrossRef]
229. Clemente-Suárez, V.J.; Mielgo-Ayuso, J.; Quiles, J.L.; Varela-Lopez, A.; Aranda, P. Effect of α-tocopherol megadoses on hematologic
parameters and antioxidant capacity of rats in an ultraendurance probe. Physiol. Int. 2017, 104, 291–300. [CrossRef]
230. Clemente-Suárez, V.J.; Martín-Rodríguez, A.; Redondo-Flórez, L.; Ruisoto, P.; Navarro-Jiménez, E.; Ramos-Campo, D.J.; Tornero-
Aguilera, J.F. Metabolic Health, Mitochondrial Fitness, Physical Activity, and Cancer. Cancers 2023, 15, 814. [CrossRef]
231. Carreira-Míguez, M.; Ramos-Campo, D.J.; Clemente-Suárez, V.J. Differences in Nutritional and Psychological Habits in Hyperten-
sion Patients. BioMed Res. Int. 2022, 2022, 1920996. [CrossRef] [PubMed]
232. Clemente-Suárez, V.J.; Redondo-Flórez, L.; Rubio-Zarapuz, A.; Martínez-Guardado, I.; Navarro-Jiménez, E.; Tornero-Aguilera, J.F.
Nutritional and Exercise Interventions in Cancer-Related Cachexia: An Extensive Narrative Review. Int. J. Environ. Res. Public
Health 2022, 19, 4604. [CrossRef] [PubMed]
233. Clemente-Suárez, V.J.; Ramos-Campo, D.J.; Mielgo-Ayuso, J.; Dalamitros, A.A.; Nikolaidis, P.A.; Hormeño-Holgado, A.; Tornero-
Aguilera, J.F. Nutrition in the Actual COVID-19 Pandemic. A Narrative Review. Nutrients 2021, 13, 1924. [CrossRef] [PubMed]

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